Unveiling Leprosy: A Systemic Review of Clinical and Cutaneous Manifestations

Abstract

Background: Leprosy It is a chronic infectious disease caused by Mycobacterium leprae, with a particular affinity for the skin and peripheral nerves. The review emphasises early diagnosis and integrated care involving dermatology and infectious disease perspectives. Aims: This systematic review aims to synthesise the main clinical and cutaneous manifestations of leprosy, emphasising the importance of early diagnosis and the benefits of an integrated care approach involving dermatology and infectious disease specialists. The study also seeks to identify diagnostic delays, atypical presentations, and care gaps that impact disease control. Methodology: Systematic literature review. Databases searched (PubMed, SciELO, LILACS, BVS, MEDLINE) between January 2015 and July 2025. The review followed PRISMA guidelines. Studies were selected based on predefined inclusion criteria, which considered original articles addressing clinical and dermatological manifestations of leprosy, diagnostic approaches, and interdisciplinary care models. Eligible designs included observational studies, cohort analyses, case reports, and literature reviews. Data extraction and quality assessment were performed independently by two reviewers, using STROBE, CASP, and the Newcastle-Ottawa Scale. A qualitative synthesis of findings was conducted. Results: Ten studies met the inclusion criteria. The most frequently reported manifestations included hypopigmented or erythematous lesions, nodules, infiltrations, type 1 and 2 lepra reactions, peripheral neuropathies, and ulcerations. Early diagnosis strategies included dermatoneurological examination, professional training at the primary care level, and the use of complementary laboratory tests. Interdisciplinary models—especially in referral centres—showed benefits in diagnostic accuracy, reaction management, and care coordination. However, gaps remain in access to services in endemic and underserved regions, in standardisation of clinical protocols, and in the availability of minimally invasive diagnostic tools. Conclusion: Leprosy continues to present diagnostic and therapeutic challenges. Integrated care between dermatology and infectious diseases improves clinical outcomes and supports timely diagnosis. Expanding access to specialised services, strengthening professional training, and incorporating structured interdisciplinary practices are essential to reduce disability and improve public health responses. Future research should evaluate the effectiveness of interdisciplinary care models in reducing diagnostic delays and improving long-term patient outcomes. Studies should also investigate scalable diagnostic innovations and their applicability in vulnerable or resource-limited populations.