only: RR, 1.18; 95% CI, 1.07 to 1.31). Similar results were obtained for the Symptom Score Reducing Index (fire needle + TCM vs. TCM: mean difference [MD], -3.39; 95% CI: -5.39 to -1.39), visual analog scale scores for itching severity (fire needle vs. halometasone cream: MD, -0.93; 95% CI, -1.29 to -0.58; fire needle + TCM vs. TCM: MD, -1.18; 95% CI, -1.78 to -0.58), and Dermatology Life Quality Index (fire needle vs. halometasone cream: MD, -3.03; 95% CI, -3.43 to -2.63; fire needle + TCM vs. TCM: MD, -2.53; 95% CI, -3.12 to -1.94). Adverse event and recurrence rates were comparable between groups. Thus, fire needle therapy alone or combined with conventional treatments may be effective for nodular prurigo, without any additional side effects.