Objective To explore the curative effect of acupuncture on mild to severe acne vulgaris. Methods A total of 200 patients with mild to severe acne vulgaris admitted to our hospital from January 2021 to December 2023 were selected as the research objects. They were divided into reference group (n =100) and acupuncture group (n =100) by random number table method. The reference group was treated with Liangxue Xiaochuang prescription, and the acupuncture group was treated with acupuncture on the basis of the reference group. The serum hormone levels, clinical efficacy and recurrence rate were compared between the two groups. Results After treatment, the levels of estradiol (E2) and luteinizing hormone (LH) in the acupuncture group were higher than those in the reference group, and the level of testosterone (T) was lower than that in the reference group (P <0.05). The total effective rate of treatment in the acupuncture group was 98.00%, which was higher than 87.00% in the reference group (P <0.05). After 3 months of follow-up, the recurrence rate of acne in the acupuncture group was lower than that in the reference group (P <0.05). Conclusion Mild to severe acne vulgaris combined with acupuncture treatment can regulate hormone levels, improve clinical efficacy, reduce disease recurrence rate, and can be used for clinical application.