Objective To explore the clinical effect of fire needle combined with traditional chinese medicine mask on the level of inflammatory factors in patients with moderate to severe acne. Methods A total of 100 patients with moderate to severe acne admitted to the Ningxia Hui Autonomous Region Integrated Traditional Chinese and Western Medicine Hospital from January 2023 to January 2024 were randomly divided into control group and experimental group, with 50 patients in each group. The reference group was treated with fire needle, and the experimental group was treated with fire needle combined with traditional Chinese medicine mask. The clinical efficacy, inflammatory factor levels and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the experimental group was 94.00%, which was higher than 74.00% in the reference group (P <0.05). After treatment, the levels of TNF-α and IL-8 in the experimental group were lower than those in the reference group (P <0.05). The incidence of adverse reactions in the experimental group was 12.00%, which was lower than 48.00% in the reference group (P <0.05). Conclusion Fire needle combined with traditional Chinese medicine mask is effective in the treatment of moderate to severe acne, which can effectively reduce the levels of serum inflammatory factors and improve the symptoms of moderate to severe acne. Meanwhile, the incidence of adverse reactions after treatment is small and the application safety is high.