Objective To analyze the effect of acupuncture combined with traditional Chinese medicine facial mask and facial blood-letting therapy on lesion improvement in acne patients. Methods A total of 106 acne patients admitted to the Department of Traditional Chinese Medicine, Rehabilitation Hospital of Kailuan General Hospital from July 2024 to July 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 53 patients in each group. The control group received acupuncture+traditional Chinese medicine facial mask therapy, and the observation group received acupuncture+traditional Chinese medicine facial mask+facial blood-letting therapy. The traditional Chinese medicine syndrome score, lesion improvement and skin barrier function were compared between the two groups. Results The traditional Chinese medicine syndrome score of the observation group after treatment was lower than that of the control group (P<0.05). The counts of comedones, papules, pustules and nodules in the observation group after treatment were less than those in the control group (P<0.05). The scores of erythema, pores and porphyrin in the observation group after treatment were higher than those in the control group (P<0.05). Conclusion The application of acupuncture combined with traditional Chinese medicine facial mask and facial blood-letting in the treatment of acne can effectively improve clinical symptoms and skin barrier function, reduce lesion counts, which is worthy of clinical application.