Objective To analyze the effect of ZKKL gold microneedle radiofrequency treatment and subcutaneous apocrine gland excision on the sweat gland secretion of patients with axillary osmidrosis. Methods A total of 70 patients with axillary osmidrosis admitted to our hospital from April 2023 to April 2024 were selected. According to the random number table method, they were divided into the control group and the study group, with 35 patients in each group. The control group received subcutaneous apocrine gland excision treatment, and the study group received ZKKL gold microneedle radiofrequency treatment. The clinical efficacy, clinical indexes, sweat gland secretion, complications and treatment satisfaction were compared between the two groups. Results The total clinical effective rate in the study group was 97.14%, which was higher than 82.86% in the control group (P <0.05). The operation time and scar length in the study group were shorter than those in the control group (P <0.05). The HDSS score in the study group was lower than that in the control group (P <0.05). The incidence of complications in the study group was 11.43%, which was lower than 31.43% in the control group (P <0.05). The treatment satisfaction rate in the study group was 94.29%, which was higher than 77.14% in the control group (P <0.05). Conclusion Compared with subcutaneous apocrine gland excision treatment, the application of ZKKL gold microneedle radiofrequency treatment for axillary osmidrosis has a better clinical effect, higher treatment satisfaction of patients, and a lower incidence of complications. At the same time, it can reduce the postoperative sweat secretion, and shorten the operation time, which is worthy of clinical application.