Objective To explore the clinical effect of fire needle combined with isotretinoin and intense pulsed light in the treatment of cystic acne. Methods A total of 70 patients with cystic acne admitted to our hospital from January to December 2022 were selected as the research objects. They were divided into control group and study group by random number table method, with 35 cases in each group. The control group was treated with isotretinoin and intense pulsed light, and the study group was treated with fire needle combined with isotretinoin and intense pulsed light. The clinical efficacy, skin lesions and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the study group was 91.43%, which was higher than 65.71% in the control group, and the difference was statistically significant (P <0.05). After 4 weeks of treatment, the skin lesion scores of the study group were lower than those of the control group, and the difference was statistically significant (P <0.05). The total incidence of adverse reactions in the study group was 11.43%, which was lower than 8.57% in the control group, but the difference was not statistically significant (P >0.05). Conclusion Fire needle combined with isotretinoin and intense pulsed light has a good clinical effect in the treatment of cystic acne, which can improve the curative effect, improve the skin lesions of patients and promote recovery on the basis of ensuring safety.