Summary Neuropathy is a well-known complication of leprosy. Nerve palpation and assessment of motor and sensory nerves are routinely performed at diagnosis in leprosy, which helps establish the diagnosis and, during treatment, monitor the status of somatic nerve function. Assessment of peripheral autonomic nerve function is not commonly practiced for diagnosing leprosy or for diagnosing and monitoring neuropathy. Early impairments in autonomic function, however, may help to establish or confirm a diagnosis and predict the development of clinical leprosy and neuropathy. Several studies, including infrared thermography and electro-neurophysiological studies, have shown the presence of subclinical nerve impairments that may indicate a diagnosis of leprosy or lead to the development of neuropathy. Sudomotor and vasomotor impairments, in the presence of loss of protective sensation, also increase the risk for ulceration, often requiring chronic care. This article provides a brief discussion of the importance and assessment of peripheral autonomic nerve function in leprosy. Its focus is to review articles that have used infrared thermography to assess this function.