Abstract: Objective To systematically evaluate the add-on effect of fire needle therapy compared to conventional treatment on alopecia areata. Methods Retrieval of CNKI, VIP, WF and PubMed databases to January 16, 2019 was included in control trial to evaluate the add-on effect of combined fire needle therapy on alopecia areata. The data were collected and analyzed by CMA software. Results A total of 73 literatures were retrieved, of which 7 control studies met the inclusion criteria. There were 490 cases included(263 cases in the combined fire needle group and 227 cases in the control group). Overall, add-on therapy of combined fire needle showed consistent benefit in the cure rate[RR=1.456, 95% CI(1.171, 1.810)], apparent efficiency[RR=1.199, 95% CI(1.055, 1.364)] and effective rate[RR=1.101, 95% CI(1.041, 1.165)]. According to subgroup analysis, when the basic treatment was local therapy, fire needle showed add-on effect on increasing the fire needle treatment can significantly improve the cure rate, apparent efficiency and effective rate;when the basic treatment were systemic therapy, fire needle only showed add-on effect on effective rate. There was no significant difference in the incidence of adverse events between the two groups[RR=1.040, 95% CI(0.267, 4.055)]. No serious adverse events were found. Conclusion Compared with the control group, the add-on effect of combined fire needle on alopecia areata is significant and safe.