Objective To explore the effect of ffre needle therapy on skin lesions and skin barrier function in patients with cystic acne. Methods A total of 58 patients with cystic acne admitted to our hospital from June to December 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 29 patients in each group. The control group was given conventional treatment, and the observation group was given ffre needle therapy. The skin lesions, skin barrier function, treatment effect and adverse reactions were compared between the two groups. Results After treatment, the scores of skin lesion manifestation, number, color and swelling-hardness in the observation group were all lower than those in the control group (P<0.05). After treatment, the skin barrier function indexes in the observation group were all better than those in the control group (P<0.05). The total effective rate of the observation group (96.55%) was higher than that of the control group (72.41%) (P<0.05). There was no statistically signiffcant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Fire needle therapy for cystic acne can effectively alleviate skin lesion status, regulate skin barrier function, improve treatment effect, and will not increase the incidence of adverse reactions, thus possessing high application value.