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Leprosy

Last reviewed: 14 Apr 2025
Last updated: 10 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • typical skin lesions
  • nerve involvement
  • sensory loss
Full details

Other diagnostic factors

  • immunologic reactions
  • eye lesions
Full details

Risk factors

  • close contact with a person with multibacillary leprosy
  • poverty
  • residence in endemic area
  • genetic predisposition
  • zoonotic transmission
Full details

Diagnostic tests

1st tests to order

  • skin smear
  • skin and/or nerve biopsy and histopathology
Full details

Tests to consider

  • polymerase chain reaction
Full details

Treatment algorithm

ACUTE

multibacillary (MB) or paucibacillary (PB): no rifampin or fluoroquinolone resistance

multibacillary (MB) or paucibacillary (PB): rifampin ± fluoroquinolone resistance

ONGOING

type 1 reaction (reversal reaction)

type 2 reaction (erythema nodosum leprosum)

Lucio phenomenon

Contributors

Authors

Maria T. Ochoa, MD

Clinical Professor of Dermatology

USC Keck School of Medicine

Department of Dermatology

Los Angeles

CA

Disclosures

MTO declares that she has no competing interests.

Acknowledgements

Dr Maria T. Ochoa would like to gratefully acknowledge Dr Denis Paul Jacques Daumerie, a previous contributor to this topic. DPJD declares that he has no competing interests.

Peer reviewers

Hubert Sansarricq, MD

Member of World Health Organization Panel of Experts on Leprosy

Saint-Armour Morlaas

France

Disclosures

HS declares that he has no competing interests.

David M. Scollard, MD, PhD

Chief

Clinical Branch

National Hansen's Disease Programs

Baton Rouge

LA

Disclosures

DMS declares that he has no competing interests.

Alexandre Tiendrebéogo, MD, MPH

Medical Officer

Leprosy and Neglected Tropical Diseases in Central Africa Countries

World Health Organization

Country Office of Kinshasa

DR of Congo

Disclosures

AT declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

World Health Organization. Towards zero leprosy. Global leprosy (Hansen’s Disease) strategy 2021-2030. Apr 2021 [internet publication].Full text

World Health Organization. Implementation of MDT. In: Multidrug therapy against leprosy: development and implementation over the past 25 years. Geneva: World Health Organization; 2004:45-68.Full text

World Health Organization. Guidelines for the diagnosis, treatment and prevention of leprosy. Oct 2018 [internet publication].Full text

World Health Organization. Leprosy/Hansen disease: management of reactions and prevention of disabilities. 2020 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Leprosy images
  • Differentials

    • Psoriasis
    • Eczema
    • Tinea corporis
    More Differentials
  • Guidelines

    • Towards zero leprosy. Global leprosy (Hansen’s Disease) strategy 2021-2030
    • Leprosy/Hansen disease: contact tracing and post-exposure prophylaxis
    More Guidelines
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