Objective: To analyze the efficacy of combining ultra-pulsed fractional CO2 laser with fire needle therapy in reducing the Clinical Erythema Assessment (CEA) score and improving the quality of life in patients with mild to moderate acne. Methods: A total of 76 patients with mild to moderate acne admitted to Qinghe County Central Hospital, Xingtai, from February 2024 to February 2025 were selected and divided into two groups (random number table method). The control group (n=38) received ultra-pulsed fractional CO2 laser treatment, while the observation group (n=38) received additional fire needle therapy. The following indicators were compared between the two groups: ① clinical efficacy; ② CEA scores; ③ quality of life [Generic Quality of Life Inventory (GQOLI-74)]. Results: The observation group (97.37%) exhibited a significantly higher total effective rate compared to the control group (78.95%) (P <0.05). Post-treatment, the observation group demonstrated lower CEA scores (P <0.05) and higher GQOLI-74 scores (P <0.05) than the control group. Conclusion: For patients with mild to moderate acne, the combination of ultra-pulsed fractional CO2 laser and fire needle therapy yields superior outcomes, significantly improving erythema conditions and enhancing quality of life.