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Last reviewed: 4 Sep 2023
Last updated: 10 Nov 2022



History and exam

Key diagnostic factors

  • typical skin lesions
  • nerve involvement
  • sensory loss
More key diagnostic factors

Other diagnostic factors

  • immunologic reactions
  • eye lesions
Other diagnostic factors

Risk factors

  • close contact with a person with multibacillary leprosy
  • poverty
  • residence in endemic area
  • genetic predisposition
  • zoonotic transmission
More risk factors

Diagnostic investigations

1st investigations to order

  • skin smear
  • skin and/or nerve biopsy and histopathology
More 1st investigations to order

Investigations to consider

  • polymerase chain reaction
More investigations to consider

Treatment algorithm


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

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


type 1 reaction (reversal reaction)

type 2 reaction (erythema nodosum leprosum)

Lucio phenomenon



Maria T. Ochoa, MD

Clinical Professor of Dermatology

USC Keck School of Medicine

Department of Dermatology

Los Angeles



MTO declares that she has no competing interests.


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



HS declares that he has no competing interests.

David M. Scollard, MD, PhD


Clinical Branch

National Hansen's Disease Programs

Baton Rouge



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


AT declares that he has no competing interests.

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  • Guidelines

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