Introduction: Leprosy is a chronic infectious disease caused by Mycobacterium leprae that primarily affects the skin and nerves. The histopathological findings in leprosy are related to the immunological status of the patient. Aim: To tabulate the incidence of different clinical and pathological patterns of leprosy and establish their correlation. Materials and Methods: A total of 118 consecutive skin biopsies of leprosy patients were studied in the Department of Pathology over 4 year duration (2010 – 2014). A Ridley-Jopling criterion was used for the diagnosis and classification of the disease. All biopsies were stained with H&E and Fite Faraco. Clinicohistopathological correlation was calculated using percentage values. Results: A total of 118 cases of leprosy were studied out of which 76 were males. The age of the patients ranged from 8 years to 76 years. Majority were in the 31-40 year age group ( n= 52.44%). Both clinically (n=55, 46.6%) and histologically (n=41, 34.7%), the maximum patients were in the BT category. Histopathologically LL (21.2%) and BB (16.1%) were the other common groups. The overall concordance between clinical and histopathological classification was 61.8%. Maximum concordance was seen in LL (79.2%) & TT (72.7%). The concordance was lower in borderline groups and least in BL (18.7%). Fite Faraco stain demonstrated acid fast bacilli in 28 cases (23.7%). Conclusion: The clinicohistopathological correlation is best at the polar ends of spectrum as compared to borderline cases. Histopathology remains the most powerful indicator of shift in patient’s immune status.