Objective To observe the clinical effect of modified Danggui Shaoyao powder and oral administration of dirithromycin combined with external application of traditional Chinese medicine mask in patients with acne vulgaris. Methods A total of 90 patients with acne vulgaris admitted to Changzhou Hospital of Traditional Chinese Medicine from January to December 2023 were selected as the research objects. They were divided into control group and experimental group by random number table method, with 45 patients in each group. The control group was treated with oral administration of dirithromycin, and the experimental group was treated with external application of traditional Chinese medicine mask combined with oral administration of modified Danggui Shaoyao powder on the basis of the control group. The symptom scores, clinical efficacy, levels of inflammatory factors and quality of life were compared between the two groups. Results After treatment, the acne score and TCM symptom score of the experimental group were lower than those of the control group (P <0.05). The total effective rate of treatment in the experimental group was 95.56%, which was higher than 80.00% in the control group (P <0.05). After treatment, the levels of TNF-α, IL-1β and IL-6 in the experimental group were lower than those in the control group (P <0.05). After treatment, the quality of life score of the experimental group was higher than that of the control group (P <0.05). Conclusion Modified Danggui Shaoyao powder and oral administration of dirithromycin combined with external application of traditional Chinese medicine mask are effective in the treatment of acne vulgaris, which can effectively reduce the degree of skin lesions and inflammation and improve the quality of life of patients.