Leprosy reactions are an important contributor to nerve damage in patients with leprosy. Thus, it is critical to timely diagnose and effectively control them to prevent further nerve damage. Diagnosis of leprosy reactions is clinical because there are no laboratory tests or markers available for confirmation. Reactions occur among patients with borderline stages (borderline tuberculoid, borderline borderline, and borderline lepromatous) and lepromatous leprosy. Reactions may present before the initiation of multidrug therapy (MDT) with antimycobacterial drugs, during the provision of MDT, or even years after completion of MDT. Currently, corticosteroids are considered the most effective drugs for managing types 1 and 2 reactions along with continuation of MDT. Occasionally, other drugs are required in some patients to treat type 1 reactions, such as clofazimine or the use of clofazimine and/or thalidomide in patients with type 2 reactions. Long-term follow-up of patients who developed leprosy reactions is critical to prevent or ameliorate nerve damage and its sequelae.