Objective To investigate the clinical efficacy of fire needling plus medication in treating cystic acne.Methods Fifty-eight patients with cystic acne were randomly allocated to treatment and control groups, 29 cases each. The treatment group received fire needling plus oral administration of isotretinoin and the control group, oral administration of isotretinoin alone. The number of cysts was observed in the two groups and the clinical therapeutic effects were compared between the two groups. Results There was a statistically significant difference in the number of cysts between before treatment and at one, two, three or four weeks after in the two groups (P<0.01,P<0.05). The total efficacy rate was 89.3% in the treatment group and 34.5% in the control group; there was a statistically significant difference between the two groups (P<0.01).Conclusion Fire needling plus medication is an effective way to treat cystic acne.