To assess the degree of skin disease in Simulium neavei s.s.-transmitted onchocerciasis, 72 patients infected with Onchocerca volvulus in the Kabarole district of Uganda were studied. They were clinically and parasitologically evaluated. Onchocercal skin lesions were determined using a modified Murdoch skin assessment, and skin scores were calculated. The chronic skin score (4.0) was associated with age, and the acute skin score (8.5) was significantly higher in males. The burden of onchocercal skin lesions was found to be high in most patients. The number of nodules (median number 1.9) and the microfilarial load (geometric mean of microfilaria 11.5) were not determinants for the burden of onchocercal skin disease in infected individuals. The study concludes that onchodermatitis is a serious medical condition in Kigoyera Parish and needs to be considered in all efforts to control onchocerciasis.