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The objective of this study was to investigate the efficacy of local injection of botulinum toxin A for treating axillary osmidrosis.One hundred and fifty patients with axillary osmidrosis were randomly divided to receive botulinum toxin A injection treatment (50 U of botulinum toxin A was injected intracutaneously into 6-20 different sites within each axilla, n =74) or surgical excision of the apocrine glands (n =76).The patients were followed up one to three months to analyze the therapeutic effect and complications of two methods.Curative effect in patients with mild and moderate axillary osmidrosis was not significantly different between botulinum toxin A injection group and operation group.However, for patients with severe axillary osmidrosis, surgery treatment seemed to be more superior to botulinum toxin A treatment (P =0.005).There was also no significant difference in the modified Dermatology Life Quality Index between two treatments.Two cases showed complications related to hemorrhage and incision infection in the operation group.In conclusion,local injection of botulinum toxin A is a safe, fast and effective treatment for mild and moderate axillary osmidrosis, but the long-term effect remains to be further investigated.