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• Photodynamic therapy for lichen sclerosus results in significant curative effect and low recurrence rate. • Fire needling combined with photodynamic therapy can increase synergy and is a good adjunct. In this work, we treated a case of stubborn bullous lichen sclerosus with photodynamic therapy(PDT) combined with fire needle. After 3 sessions of PDT ,pretreated with fire needle, most of the patient's skin lesions subsided and symptoms improved significantly. We found that photodynamic therapy is a potential treatment modality for lichen sclerosus with significant efficacy. Combined with fire needle pretreatment, which may not only promote the transdermal absorption of the drug, but also play a synergistic effect. [ABSTRACT FROM AUTHOR]