目的 探究火针联合脉冲激光、红霉素软膏治疗囊肿型痤疮的疗效及对血清卵泡生成素（FSH）、黄体生成素（LH）、雌二醇（E₂）水平及皮损状况影响的临床研究。 方法 研究对象选择为2022年7月至2023年12月武汉科技大学附属老年病医院收治的囊肿型痤疮患者，按照随机数字表法分为4组，对照组采用火针治疗，联合1组采用火针联合脉冲激光治疗，联合2组采用火针联合红霉素软膏治疗，联合3组采用火针联合脉冲激光、红霉素软膏治疗，以1个月为1个疗程，4组患者均治疗3个疗程。采用倾向性匹配（PSM）研究方法，按照1∶1∶1∶1比例将4组患者临床资料进行匹配，比较4组患者疗效、治疗前及治疗后的性激素水平、皮损情况、皮肤屏障功能及不良反应。 结果 PSM前共纳入204例患者（对照组51例，联合1组51例，联合2组51例，联合3组51例），PSM后4组均为40例，一般资料比较差异无统计学意义（P > 0.05），具有可比性；4组临床有效率比较差异有统计学意义，联合3组有效率为92.50%，高于对照组的65.00%与联合2组的75.00%（P < 0.05），与联合1组的85.00%比较差异无统计学意义（P > 0.05）；4组治疗后血清FSH、LH、E₂水平均较治疗前上升，联合3组高于对照组、联合1组与联合2组（P < 0.05）；4组治疗后皮损积分均下降，联合3组低于对照组、联合1组与联合2组（P < 0.05）；4组治疗后的角质层含水量上升，经皮水分散失（TEWL）、黏脱蛋白质含量及皮肤红斑情况（a值）均下降，联合3组的角质层含水量高于对照组，TEWL低于对照组、联合2组，a值低于对照组、联合1组与2组，黏脱蛋白质含量低于对照组（P < 0.05）；4组患者治疗期间发生的不良反应包括瘙痒、红肿、轻度出血等，联合3组不良反应发生率为20.00%，略高于对照组、联合1组与联合2组，但4组不良反应发生率比较差异无统计学意义（P > 0.05）。 结论 火针联合脉冲激光、红霉素软膏治疗囊肿型痤疮具有良好的疗效，可改善患者性激素水平以及皮损情况，且不会显著增加不良反应发生情况，具有良好的临床应用价值。

Objective To investigate the efficacy of fire needling combined with pulsed laser and erythromycin ointment in treating cystic acne， as well as its impact on the levels of serum follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， and estradiol （E2）， and skin lesions. Methods A total of 204 patients diagnosed with cystic acne and admitted to the Geriatric Hospital Affiliated to Wuhan University of Science and Technology between July 2022 and December 2023 were included in this study. By using a random number table method， they were divided into four groups： the control group， which received fire-needling treatment； combination group 1， treated with fire needling plus pulsed laser； combination group 2， treated with fire needling plus erythromycin ointment； and combination group 3， treated with fire needling， pulsed laser， and erythromycin ointment. With a treatment course of one month， all groups underwent three courses of treatment. Propensity score matching （PSM） was employed to match the clinical data at a ratio of 1∶1∶1∶1. The efficacy， sex hormone levels before and after treatment， severity of skin lesions， skin barrier function， and adverse reactions were compared among the groups. Results Before PSM， a total of 204 patients were included in the study， with 51 cases allocated to each group. After PSM， each group was composed of 40 patients， and their baseline data were comparable （P > 0.05）. There were significant differences in the clinical effective rates among the groups. Specifically， the effective rate in combination group 3 was 92.50%， which was significantly higher than that in the control group （65.00%） and combination group 2 （75.00%） （P < 0.05）. Nevertheless， there was no statistical difference when compared with combination group 1 （85.00%）. After treatment， the serum levels of FSH， LH， and E2 increased in all groups. Among them， combination group 3 showed the highest levels of these hormones （P < 0.05）. Additionally， the skin lesion scores of all groups decreased after treatment， and combination group 3 had the lowest scores （P < 0.05）. Regarding skin physiological parameters， after treatment， the stratum corneum water content increased in all groups， whereas the transepidermal water loss （TEWL）， the content of mucins and proteins related to desquamation， and skin erythema （a value） decreased. Combination group 3 had a higher stratum corneum water content than the control group， lower TEWL than the control group and combination group 2， a lower a value than the other three groups， and lower content of mucins and proteins related to desquamation than the control group （P < 0.05）. The adverse reactions that occurred during treatment included itching， redness， swelling， and mild bleeding. The incidence of adverse reactions in combination group 3 was the highest， reaching 20.00%. However， there was no significant difference in the incidence of adverse reactions among the four groups （P > 0.05）. Conclusions The combined use of fire needling， pulsed laser， and erythromycin ointment is effective in treating cystic acne. It can improve patients' sex hormone levels and skin lesions without a significant increase in adverse reactions， which demonstrates favorable clinical application value.