<p>Exoskeletons in the industry have been adopted as an ergonomic factor to reduce musculoskeletal injuries. It has gained space over the last decade, mainly with its introduction to Industry 4.0. However, evaluating this technology is incipient and limits its applicability. This study aims to investigate the use and efficiency of exoskeletons in industrial environments. Through a systematic literature review, we found 58 peer-reviewed studies addressing the applicability, efficiency, validation parameters and trends in using the exoskeleton. The results are built upon a framework that classifies benefits and challenges, presenting the impact of the exoskeleton on three levels of the industrial ecosystem: ergonomic, organisational and individual. The main benefits are the reduction of shoulder overload, the effects on the workers’ quality of life, and the reduction of injuries. The challenges are related to limitations in the assessment methodology, design problems, unreported long-term risks and low interest. Finally, we present directions for future research addressing emerging themes, such as evaluation methodologies, equipment design, ergonomics, and side effects. Thus, by providing an in-depth analysis of the industrial ecosystem levels, barriers, benefits and research agenda, our study contributes to improving, enhancing and disseminating the use of exoskeletons in manufacturing and service industries.</p>