Objective To explore the effect of filiform fire needle combined with red and blue light therapy on skin lesion improvement in patients with inflammatory acne. Methods A total of 90 patients with inflammatory acne admitted to the Department of Dermatology, Chongqing Rongchang Hospital of Traditional Chinese Medicine from October 2024 to May 2025 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 45 patients in each group. The control group was given red and blue light therapy, and the observation group was given filiform fire needle combined with red and blue light therapy. The skin lesion improvement, clinical efficacy, inflammatory factor levels, quality of life and adverse reaction rate were compared between the two groups. Results The skin lesion score of the observation group after treatment was lower than that of the control group (P <0.05). The total effective rate of the observation group was higher than that of the control group (P <0.05). The levels of IL-17 and IL-18 in the observation group after treatment were lower than those in the control group (P <0.05). The quality of life score of the observation group after treatment was higher than that of the control group (P <0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion The combined application of filiform fire needle and red and blue light therapy in patients with inflammatory acne can further improve clinical efficacy, alleviate inflammatory response, reduce skin lesion status, improve quality of life, and has few adverse reactions.