Breakout Bulletin: May 10-15

You’re busy. Between patients, prior authorizations, inbox messages, and everything else on your plate, keeping up with the literature is the first thing that slips. Dermatology Times NP/PA Connect is here to make sure it doesn’t. Each week, we pull the most clinically relevant news from across dermatology and bring it straight to your inbox — what’s new, what it means, and what’s worth watching. This week: a surprisingly simple way to reduce pain during cosmetic injections, 2 important hidradenitis suppurativa (HS) studies, precision dosing for adalimumab in psoriasis, and an unconventional immunotherapy approach showing early promise in chronic spontaneous urticaria (CSU).

LAST WEEK’S HEADLINES

Music, White Noise, and Cosmetic Injection Pain

A new prospective controlled study suggests that listening to music or white noise during cosmetic botulinum toxin injections may meaningfully reduce procedural pain and stress — especially for first-time patients.¹

The study evaluated 76 women undergoing upper-face neurotoxin treatment. Patients in the music arm listened to self-selected songs, while the white noise group heard a standardized recording resembling a hair dryer. Both interventions started 10 minutes before injections and continued through recovery.

Pain scores were lower in both intervention groups compared with controls, dropping from 6.80 in the control group to 5.70 with music and 5.52 with white noise. Interestingly, first-time toxin patients experienced significantly more pain only in the control arm; the difference disappeared when music or white noise was used.

Nearly all participants said they would want the intervention repeated during future procedures.

▶ Why it matters: Cosmetic dermatology often focuses on products and technique, but patient experience matters too. Music and white noise are inexpensive, easy to implement, and may meaningfully reduce anxiety and discomfort during injections.

MORE ON AESTHETICS

HS, Bariatric Surgery, and the Complexity of Weight Loss

A new cross-sectional study adds nuance to the conversation around bariatric surgery and HS outcomes.² Among 135 adults with HS, patients who had undergone bariatric surgery reported numerically lower pain, depression, anxiety, and quality of life impairment scores compared with patients who had not undergone surgery — but none of the differences remained statistically significant after adjustment.

The findings highlight how complicated the obesity-HS relationship may be. Weight reduction may improve inflammatory burden and friction, but some patients continue to struggle with scarring, chronic pain, nutritional deficiencies, or excess skin folds after surgery.

One finding stood out clearly: pain correlated strongly with impaired quality of life, depression, and anxiety scores.

▶ Why it matters: Patients frequently ask whether bariatric surgery will improve HS. This study suggests the answer is likely individualized rather than universal — and reinforces that pain remains one of the central drivers of overall disease burden.

MORE ON HS

Earlier HS Diagnosis Changes the Entire Patient Journey

A large retrospective study led by Raj Chovatiya, MD, PhD, found that patients with formally diagnosed HS experienced faster biologic initiation, lower hospitalization rates, fewer emergency department visits, and lower overall health care costs compared with patients with suspected but undiagnosed disease.³

Adult patients with confirmed HS started biologics roughly 56 days sooner than suspected-HS patients and were substantially more likely to receive biologic therapy overall. Confirmed HS patients also demonstrated dramatically lower 30-day hospitalization and ED utilization rates.

But the study also underscored persistent disparities. Hispanic and Black patients experienced longer delays before biologic initiation, while pediatric Medicaid patients also waited substantially longer than commercially insured peers.

▶ Why it matters: Diagnostic delay in HS is not just frustrating — it appears tied to worse outcomes, higher acute-care utilization, and higher costs. Early recognition matters, but equitable access after diagnosis matters just as much.

MORE ON INFLAMMATORY DISEASES

Precision Dosing for Adalimumab in Psoriasis

New pharmacokinetic/pharmacodynamic modeling research suggests proactive therapeutic drug monitoring (TDM) may improve outcomes for psoriasis patients receiving adalimumab.⁴

Using real-world data from more than 500 patients, investigators modeled a strategy in which trough drug levels were checked early during therapy and dosing adjustments were made accordingly. Compared with standard every-2-week dosing, the proactive strategy improved simulated PASI90 rates from 28.3% to 38.9%.

The model also identified patients unlikely to benefit from continued dose escalation despite low drug levels, suggesting TDM could help identify when switching biologic classes may be more effective than simply increasing dose frequency.

▶ Why it matters: Dermatology may be moving toward more individualized biologic management. Proactive TDM could eventually help clinicians decide who needs more drug, who needs less, and who needs an entirely different mechanism of action.

MORE ON PSORIASIS

An Unusual Immunotherapy Approach for CSU

A small pilot study is exploring intramuscular injections of autologous total IgG as a treatment for antihistamine-refractory CSU.⁵

Investigators collected patients’ own plasma-derived IgG and administered weekly injections over 9 weeks. By week 12, patients demonstrated meaningful improvements in urticaria activity, disease control, and quality of life, with benefits persisting through week 24. More than one-quarter of participants achieved complete remission by the end of follow-up.

No serious adverse events were reported.

The study was small, open-label, and uncontrolled, so conclusions remain limited. Still, the durability of response in a highly refractory population makes the signal difficult to ignore.

▶ Why it matters: Omalizumab transformed CSU management, but refractory disease remains common. An autologous immunomodulatory strategy would represent a very different therapeutic direction — one still early, but worth watching.

LATEST NP/PA NEWS

References

1. Ozgen Z. Do White noise or music relieve pain caused by botulinum toxin injections?. Pain Res Manag. 2026;2026(1):e3007685. doi:10.1155/prm/3007685
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, 19. 2026. doi:10.2147/CCID.S584656
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. JID Innov. 2026;6(3):100462. Published 2026 Feb 24. doi:10.1016/j.xjidi.2026.100462
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. Clin Transl Sci. 2026;19(5):e70563. doi:10.1111/cts.70563
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. Exp Dermatol. 2026;35(4):e70249. doi:10.1111/exd.70249