Onchocerciasis, or river blindness, in darker-skinned individuals often causes intense itching, skin nodules, and depigmentation, particularly in areas of chronic infection. The disease, transmitted by blackfly bites of the genus Simulium, can lead to progressive vision loss and skin changes, including thickening and a “leopard skin” appearance. Symptoms are due to the reaction of the body to the dying Onchocerca volvulus microfilariae. Treatment involves administering ivermectin to kill the larvae, with repeated doses to control the infection, and sometimes doxycycline to target the adult worms.