Efficacy and Safety of Three Needling Patterns for Microneedle Radiofrequency in Axillary Osmidrosis: A Prospective Randomized Trial.

Axillary osmidrosis (AO) is a common dermatological disorder characterized by malodorous axillary secretions, which severely impairs patients' quality of life and psychological status. Microneedle radiofrequency (MNRF) has emerged as a minimally invasive alternative to traditional surgical treatment owing to its favorable efficacy and safety profile; however, clinical needling patterns currently lack standardized, evidence-based criteria and largely rely on individual experience, potentially leading to inconsistent therapeutic outcomes and variable risks of adverse events. This prospective randomized controlled trial enrolled 90 patients with moderate-to-severe axillary osmidrosis to comprehensively evaluate the efficacy and safety of a novel zone-directed needling pattern (ZD), with full transverse needling (FT) and full longitudinal needling (FL) set as conventional control techniques. All participants completed a 6-month clinical follow-up, and therapeutic outcomes, quality-of-life improvements reflected by the dermatology life quality index (DLQI), and early postoperative adverse events, including erythema, swelling, and pain, were systematically compared among the three groups. The ZD needling pattern achieved high clinical effectiveness (90.0%) comparable to FL (93.3%), with a safety profile closer to FT, while FT showed lower 6-month efficacy (53.3%) and a higher recurrence rate (40.7%). The FL group, despite high efficacy, exhibited a significantly higher incidence of short‑term adverse reactions. The present findings demonstrate that the optimized ZD needling strategy effectively balances therapeutic efficacy and procedural safety by integrating the advantages of conventional longitudinal and transverse needling modes, providing a standardized, evidence-based MNRF manipulation protocol for axillary osmidrosis treatment.