Skin Picking Disorder in India: A Systematic Review of Clinical Characteristics, Comorbidities, and Treatment Outcomes from Published Case Reports and Case Series

Purpose of the review: To characterize the clinical features, comorbidity patterns, and treatment outcomes of skin picking disorder (SPD) in Indian populations based on published case reports and case series. Collection and Analysis of Data: A systematic review and exploratory descriptive meta-analysis of case reports and case series. PubMed/MEDLINE, Embase, PsycINFO, IndMed, Shodhganga, and Google Scholar were searched through 10 December 2025. Titles, abstracts, and full texts were screened independently by two reviewers; disagreements were resolved by consensus. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists for case reports (8 items) and case series (10 items). The primary outcome was pooled treatment response, analyzed using the Freeman-Tukey double arcsine transformation and a DerSimonian-Laird random-effects model, with results treated as exploratory and hypothesis-generating only. Certainty of evidence (CoE) was evaluated using GRADE. Results: Six studies ( k = 6) comprising 10 patients ( n = 10) were included. The JBI appraisal indicated that most included studies satisfied most relevant signaling questions; however, most domains could not be assessed for one anonymous conference abstract due to format limitations. Narrative synthesis revealed a 90% anxiety comorbidity rate and a mean diagnostic delay of 2.6 years. The exploratory meta-analysis ( k = 5, n = 9) yielded a pooled SSRI treatment response rate of 81% (95% CI: 54%–97%; I 2 = 0%), which should be interpreted as hypothesis-generating only given the critically small evidence base. CoE was VERY LOW for all outcomes. Conclusions: The SPD in Indian populations is characterized by elevated, culturally mediated anxiety comorbidity and protracted diagnostic delays. All quantitative estimates are strictly hypothesis-generating, given that the evidence base comprises 10 patients across six case-level studies. Adequately powered prospective trials and integrated psychodermatology services are urgently needed.