Aim: We aimed to measure the degree to which onchocercal skin disease (OSD) impairs quality of life (QoL) in endemic resource-poor communities in the Ushongo, Kwande, and Katsina-ale local government areas of Benue State, Nigeria. Methods: We evaluated the skin characteristics and QoL of 307 children and adults with OSD using a modified dermatological life quality index (mDLQI). Assessment of OSD was conducted and scored using mDLQI from 0 (no effects) to 18 (large effects). Thereafter, structured questionnaires were applied to assess the knowledge, attitudes, and predictors of moderate and severe OSD patients. Results: In total, 235/307 (76.5%) participants presented onchocercal nodules; chronic papular dermatitis was found in 68 (22.1%). A total of 288 (93.8%) had two or more OSD-associated symptoms. The median mDLQI score was 0 [interquartile range (IQR): 0-0] in children and 5 in adults (IQR: 2-8). A higher mDLQI median score was observed in farmers. There was a statistically significant difference between children and adults (P < 0.001). The most frequently reported impairments were social exclusion, embarrassment/shame, and restriction from work/leisure activities. In logistic regression analysis, there was a significant association with increasing age (adjusted odds ratio (AOR) = 1.44; 95%CI: 1.21-1.71; P < 0.001) and visual impairment (AOR = 1.78; 95%CI: 1.02-3.10; P = 0.040) with severe mDLQI. Papular rash was an independent protective factor (AOR = 0.50; 95%CI: 0.27-0.93; P = 0.030). Conclusion: Onchocerciasis-related morbidity has a profound measurable impact on the individual QoL, affecting the overall socioeconomic well-being of the affected community, if left untreated. Therefore, strict supervision and follow-up of home-based mass treatment with ivermectin are vital for successful control of the disease and to reduce the burden on affected communities.