How Auditory Distraction Eases Pain During Cosmetic Botulinum Injections

Why this matters

Recent research in dermatology shows something many patients already feel: getting better skin isn’t only about new drugs. How and when care happens, the way treatments are given, and small steps to reduce anxiety and pain all change results. Below I walk through several new studies and what they may mean for people living with common skin problems.

Making cosmetic procedures less painful with sound

Many people get injections of botulinum toxin (often used for cosmetic smoothing of wrinkles). A new study tested whether listening to music or white noise during the shots could reduce pain.

Both patient-selected music and standardized white noise lowered the average pain score compared with the usual clinic sounds. The effect was strongest in people getting these injections for the first time — first-timers tended to report more pain than people who’ve had injections before. Nearly everyone who tried the sound options said they’d like to use them again: 85% in the music group and 96.8% in the white noise group (Source: Ozgen Z., Do White noise or music relieve pain caused by botulinum toxin injections?, 2026).

What this means: Playing music or white noise is an inexpensive, simple way clinics might make procedures more comfortable — especially for nervous or first-time patients. The study also reminds us that reducing anxiety can make pain feel less intense.

Hidradenitis suppurativa (HS): weight loss helps, but it’s not the whole story

Hidradenitis suppurativa (HS) is a long-lasting skin condition that causes painful lumps and scarring in areas like the armpits and groin. A cross-sectional study from Saudi Arabia looked at people with HS who had bariatric (weight-loss) surgery and compared measures like pain, depression, anxiety, and quality of life.

The people who’d had surgery tended to have lower average scores for skin-related quality of life, depression (measured by PHQ-9), anxiety (GAD-7), and pain. However, after adjusting the data statistically, those differences were no longer considered significant. Still, the pattern was clear: pain levels were closely linked to how much HS interfered with daily life and mental health (Source: Alsukait S. et al., Impact of bariatric surgery on quality of life and psychological well-being among patients with hidradenitis suppurativa, 2026).

What this means: Losing weight can help some aspects of HS, but it may not fix everything. Scarring, ongoing pain, extra skin folds after weight loss, and nutritional changes after surgery can continue to cause problems. The study supports using simple pain assessments as a quick way to check how much HS is affecting someone’s life and mood.

Getting an HS diagnosis sooner changes the care path

A large review of medical records found that people with a formal HS diagnosis started advanced treatments called biologics faster and had fewer emergency or hospital visits than people who likely had HS but were never officially diagnosed.

• Median time to start a biologic: about 110 days for confirmed HS vs 166 days for suspected but undiagnosed HS.
• 30-day hospitalization risk: 0.8% for confirmed HS vs 3.7% for suspected HS.
• 30-day emergency department visit risk: 2.6% for confirmed HS vs 11.7% for suspected HS (Source: Chovatiya R. et al., Patient journey and disparities in the diagnosis and treatment of patients with hidradenitis suppurativa, 2026).

The study also found racial and social disparities: Hispanic and Black patients had longer delays before starting biologics, and people living in higher social vulnerability areas faced delayed access to care.

What this means: Recognizing and documenting HS earlier can speed up access to treatments and reduce urgent care visits. But diagnosis alone won’t fix deeper inequalities in access to care — those need separate attention.

Psoriasis: using drug levels to guide treatment decisions

Psoriasis is an inflammatory skin disease often treated with biologic drugs such as adalimumab. A large pharmacokinetic/pharmacodynamic modeling study explored whether monitoring drug levels in the blood — called therapeutic drug monitoring (TDM) — could help tailor treatment.

In computer simulations, TDM-guided dose adjustments improved outcomes: the rate of people achieving a 90% improvement in disease (PASI90) rose from about 28% to 39%, and the 75% improvement rate (PASI75) rose from about 62% to 70%.

The model also found two useful groups: people who kept having low drug levels even after increasing the dose (and were less likely to reach PASI90), and people doing well who might keep control even if the dose were reduced (Source: Pan S. et al., Evaluation of a therapeutic drug monitoring strategy for adalimumab in psoriasis, 2026).

What this means: Measuring biologic drug levels could help doctors decide whether to increase, decrease, or switch treatments instead of guessing. Note this study used simulations rather than following patients prospectively, so real-world trials are needed to confirm the benefits.

Chronic spontaneous urticaria (CSU): a small pilot of autologous IgG injections

Chronic spontaneous urticaria (CSU) is a type of hives that comes and goes for months without an obvious trigger. A small, open-label pilot study tested intramuscular injections of patients’ own total IgG (a component of the immune system) in people whose hives didn’t respond to antihistamines.

Over 24 weeks, researchers reported improvements in disease activity scores (UAS7 decreased by a median of 13 points), better symptom control (UCT improved by a median of 4 points), and about 27% of people who completed follow-up reached complete remission at week 24. No serious side effects were reported (Source: Ye YM. et al., Clinical efficacy and safety of intramuscular injections of autologous total IgG in patients with chronic spontaneous urticaria, 2026).

What this means: These early results are interesting because benefits lasted beyond the treatment period, suggesting a possible immune-modifying effect. But the trial was small and not placebo-controlled, so larger controlled studies are needed before this becomes a routine option.

When to see a doctor

Talk to a dermatologist or your primary care doctor if you have:

• New or worsening painful lumps, draining nodules, or scarring in skin folds (possible HS).
• Persistent hives lasting weeks to months, or hives that don’t respond to over-the-counter antihistamines (possible CSU).
• Widespread or treatment-resistant psoriasis, or if your psoriasis is affecting your quality of life.
• Concerns about pain or anxiety before cosmetic procedures.

For serious symptoms such as rapidly growing or bleeding lesions, signs of infection (fever, increasing redness, warmth, pus), or severe uncontrolled pain, seek urgent medical care.

Notes on tracking visible changes

Keeping a simple photo diary can help you notice how a rash, lump, or scar changes over time and makes it easier to share accurate information with your clinician at appointments.

Quick disclaimer

This article is informational. It summarizes recent studies and does not replace medical advice. Treatment decisions should be made with your doctor or dermatologist. For possible new or worsening problems, see a healthcare professional.

Sources

1. Ozgen Z. Do White noise or music relieve pain caused by botulinum toxin injections?. 2026;2026(1):e3007685. doi:10.1155/prm/3007685 (Source: Ozgen Z., Do White noise or music relieve pain caused by botulinum toxin injections?, 2026).
2. Alsukait S, Alotaibi H, Alkofide M, et al. Impact of bariatric surgery on quality of life and psychological well‑being among patients with hidradenitis suppurativa: a cross‑sectional study. Clinical, Cosmetic and Investigational Dermatology. 2026. doi:10.2147/CCID.S584656 (Source: Alsukait S. et al., Impact of bariatric surgery on quality of life and psychological well‑being among patients with hidradenitis suppurativa, 2026).
3. Chovatiya R, Gayle J, Low R, Oh T, Gomez I, Rosenthal N. Patient journey and disparities in the diagnosis and treatment of patients with hidradenitis suppurativa. Published 2026 Feb 24. doi:10.1016/j.xjidi.2026.100462 (Source: Chovatiya R. et al., Patient journey and disparities in the diagnosis and treatment of patients with hidradenitis suppurativa, 2026).
4. Pan S, Tsakok T, Wei R, et al. Evaluation of a therapeutic drug monitoring strategy for adalimumab in psoriasis: a prospective pharmacokinetic‑pharmacodynamic study. doi:10.1111/cts.70563 (Source: Pan S. et al., Evaluation of a therapeutic drug monitoring strategy for adalimumab in psoriasis, 2026).
5. Ye YM, Kim ME, Kwon B, Nahm DH. Clinical efficacy and safety of intramuscular injections of autologous total IgG in patients with chronic spontaneous urticaria: an open‑label prospective pilot trial. doi:10.1111/exd.70249 (Source: Ye YM. et al., Clinical efficacy and safety of intramuscular injections of autologous total IgG in patients with chronic spontaneous urticaria, 2026).