Leprosy is a chronic infectious disease mainly affecting the skin and peripheral nerves. The clinicopathological manifestations are a reflection of the strength of cell-mediated immunity (CMI). In lepromatous leprosy (LL), the CMI is severely impaired, leading to multiple, symmetrical, diffuse infiltrated lesions like macules, plaques, and nodules over the skin. However, this disease can manifest as a variety of unusual presentations, like non-healing ulcers, transient tender erythematous nodules, fever, pedal oedema, polyarthritis, radiating pain, nasal stuffiness, and epistaxis are not uncommon. These atypical manifestations are easily overlooked, leading to misdiagnosis if there is no strong clinical suspicion. Early diagnosis and timely administration of multibacillary multidrug therapy (MB MDT) are essential to prevent permanent and progressive deformities. We report four atypical cases of LL that were misdiagnosed outside as eczema (Case 1), molluscum contagiosum (Case 2), psoriasis (Case 3) and furunculosis (Case 4). Thus, this case series highlights the importance of detailed history taking, thorough clinical examination, slit skin smear and histopathological examination, especially in endemic countries, to diagnose this disease with various faces as early as possible to reduce the risk of deformities and transmission in society and achieve eradication. © 2024 Elsevier B.V., All rights reserved.