Objective To explore the efficacy of fire needle combined with traditional Chinese medicine mask in the treatment of cystic acne and its impact on skin barrier function. Methods A total of 61 patients with cystic acne admitted to Suzhou High-Tech Zone Hospital of Traditional Chinese Medicine from January 2024 to January 2025 were selected as research subjects, and they were divided into the control group (30 patients) and the observation group (31 patients) by the random number table method. The control group was treated with conventional western medicine, and the observation group was treated with fire needle combined with traditional Chinese medicine mask. The clinical efficacy, skin barrier function and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group (96.67%) was higher than that in the control group (73.33%) (P <0.05). After treatment, the skin desmosomal protein and transepidermal water loss in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group (P <0.05). After treatment, the stratum corneum hydration in the two groups was higher than that before treatment, and that in the observation group was higher than that in the control group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion Fire needle combined with traditional Chinese medicine mask has a definite effect in the treatment of patients with cystic acne, which can effectively improve their skin barrier function, with good safety.