Contagion Options: Ichthyosis

Eric Lis

In a previous post I suggested one of the nastiest diseases a spellcaster might choose to inflict on a victim (Contagion Options: Necrotizing Fasciitis). As any evil overlord knows, however, not every situation calls for the most horrific spell in your arsenal. Here’s an option for contagion that’s perfect for when a caster wants to be annoying or humiliating without being debilitating or cruel.


Minimum caster level: 5

A creature magically afflicted with this disease develops a rapid-onset thickening of the skin. When the spell is cast, the target immediately suffers 1 point of Dexterity drain and 1 point of Charisma drain, but also gains a natural armour of 1. Any effects which remove the ability score drain also removes the natural armour bonus.

Starting the next day, and each day for a number of days equal to the number of caster levels the caster is above 5, the target must succeed on a Fortitude save equal to the original spell DC or suffer 1 additional point of Dexterity and Charisma drain. This effect cannot reduce any one of a creature’s ability scores by more than 4 regardless of how many saves the creature fails.

Ichthyosis describes a group of disorders wherein a creature’s skin becomes dry, scaly, and as indicated by the name, fish-like. The disorder can range from the very mild, to the point where it causes no more annoyance that a bit of itching, to the rare and severe forms, where the skin becomes thickened to the point of losing its ability to bend and fold. The scaly appearance may be off-putting to others and can become disfiguring. If skin becomes very dry, it can crack, leaving the body vulnerable to bacterial infections that would normally be unable to enter. In rare cases the scaling has been observed to take on an almost spiky appearance; while in D&D terms this may sound like it would make for very cool natural armour, this form of the disorder tends to occur with hearing loss and other problems which prevent it from being converted into a desirable feat.

In nature, ichthyosis is typically a genetic disorder and is therefore something that a creature is born with. Severe forms tend to be present from birth, where more common forms may manifest later, or simply never be noticed until later. Several different mutations are known to cause ichthyosis-like syndromes, as the skin is an incredibly complex structure made up of numerous elements in careful balance. When ichthyosis appears in someone without one of the genetic mutations, it’s often a sign of one of several cancers.

There aren’t many treatments for ichthyosis in our world. It usually doesn’t need much in the way of treatment beyond moisturizing cream, but this leaves us very stuck in the rarer severe cases, where the unsettling appearance becomes less important than preventing life-threatening infections. There’s been some early work in gene-therapy which may show some promise, but as gene therapy has been famously described as being perpetually ten years away from being clinically useful, this isn’t of immediate use. Obviously, as with most diseases, ichthyosis is easier to treat in a magical setting, although even then, it probably remains a challenge. If ichthyosis is caused by a spell such as contagion then it should probably be treatable with a simple remove disease or perhaps remove curse spell, but if it is inborn, then it should probably require nothing short of a wish or miracle to reverse. Alternately, symptoms such as skin thickening and cracking might be treatable as easily as casting a prestidigitation spell once per day to remoisturize. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on December 13, 2015. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system