Background: The emotional and social sequelae of primary axillary hyperhidrosis (PAH) mandate the search for new techniques. The study aimed to compare the efficacy and safety of diode laser-980 nm versus intradermal Botulinum toxin A (BTA) in the management of PAH. Patients and methods: This parallel-randomized controlled pilot study was conducted upon 40 PAH patients from December-2019 to June-2021 at the National Institute of Laser Enhanced Sciences (NILES), Egypt; the laser group (20 cases) and the BTA group (20 cases). Results: The two groups were comparable regarding age, BMI, and gender (p-values > 0.05). Females constituted 60% & 65% of the laser group & the BTA group, respectively. The laser group had higher reduction of HDSS score than the BTA group at 1-month (1.40±0.50 versus 2.05±0.69; p-value = 0.002) and at 6-months (1.35±0.49 versus 2.35±0.59; p-value < 0.001). At 1-month and 6- months, the laser group had a higher reduction of the mean of moisture percentage than the BTA group (p-values < 0.001). At 1-month, there was a higher patient satisfaction in the laser group 3.5±0.61 than in the BTA group 3.10±0.71 (p-value = 0.036). At 6-months, the difference became more evident with the higher satisfaction in the laser group 3.30±0.73 than the BTA group 2.50±0.51, (p-value < 0.001). The laser group demonstrated significantly better DLQI score than the BTA group at both 1-month (p-value = 0.010) and 6-months visits (p-value < 0.001). Conclusion: The study showed that Diode laser 980 nm is effective and safe as a treatment for PAH.