To observe the clinical effect of filiform fire needle combined with Shenque moxibustion in the treatment of chronic actinic dermatitis. Methods Sixty patients with chronic actinic dermatitis admitted to the Department of Dermatology, the First Affiliated Hospital of Dali University from October 1, 2021 to December 30, 2022 were randomly divided into control group and treatment group, with 30 patients in each group. The control group was treated with conventional western medicine, and the treatment group was treated with filiform fire needle combined with Shenque moxibustion on the basis of the control group. The clinical efficacy, symptoms, sleep scores and recurrence of the two groups were compared. Results The total effective rate of the treatment group was 96.67%, which was higher than 86.67% of the control group (P <0.05). After treatment, the scores of subjective symptoms, objective symptoms and total symptoms in the treatment group were lower than those in the control group (P <0.05). After treatment, the sleep score of the treatment group was lower than that of the control group (P <0.05). The recurrence rate of the treatment group was 23.33%, which was lower than 40.00% of the control group, but the difference was not statistically significant (P >0.05). Conclusion The effect of filiform fire needle combined with Shenque moxibustion in the treatment of chronic actinic dermatitis is exact, which can effectively improve the clinical symptoms such as pruritus, improve sleep quality and reduce the risk of recurrence. It is a safe and effective treatment plan.