Your skin has keratin growing in places besides the usual fingernails and toenails. In people who normally have scales or other hardened skin, this manifests in random protrusions. Because these areas are not well-rooted like nails, they make skin more fragile. If you wear armor, you must wear additional padding to protect your skin from it or lose (IE) hit points per day as it snags, so you have disadvantage on Constitution saving throws in extreme heat as outlined in official fifth edition sources. Because of frequent lesions in your skin, you must succeed on a DC 5 + (IE) Constitution saving throw every day or develop Infection.

Real-world Examples

Epidermolytic Hyperkeratosis, Ichthyosis, Olmsted Syndrome, Pachyonychia Congenita

Assistive Options

A daily bath in salt water, followed by applying oil to the skin will reduce the IE by 1 for one day.

Magical Assistance

Mage Armor and other non-armor protection can be used without the penalties normally associated with this condition.

Even if you have a myriad of problems, somewhere out there are friends for you too, and what other people see as mundane can be an adventure. Don’t judge a book by its cover. You’ll never know what’s inside, or why.

-Anna Pz

Your body has colors or patterns not normally associated with your ancestry, usually one or more amorphous shapes on the skin covering 15 percent × (IE). These may be due to blood vessel abnormalities, burn scars, pigment differences, moles, or magical causes, and unless caused by injury, they typically don’t feel different from other skin. While this coloration typically ranges from red to brown or black in the real world, magical causes could result in any number of colors (Choose randomly from https://www.random.org/colors/hex) or patterns, transparency, or even changing or moving. Consequently, when people who don’t know you see you, they especially notice these differences. This gives you +(IE) to Dexterity (Sleight of Hand) checks but −(IE) (up to −4) to disguise checks or Dexterity (Stealth) checks to blend into a crowd as well as a −(IE) penalty on Charisma (Persuasion) checks due to many people’s discomfort around those with unexpected appearances.

Note that this is usually a permanent condition and does not fluctuate, but the player and GM are welcome to determine a magical version that fluctuates based on the Frequency table. Classic stimuli include sunrise/sunset, fluctuation of the moon, or mood changes.

Real-world Examples

Burns, Vitiligo, Birthmarks, Melasma, Tinea Versicolor, Rosacea, Psoriasis

Assistive Options

Players can attempt to conceal the coloration using clothing, makeup, or a tattoo, but a Wisdom (Perception) check against the character’s disguise skill (or the tattoo artist’s disguise skill) will notice the color difference if not covered with clothing. Makeup will need to be monitored and reapplied daily or when exposed to water or sweat.

Magical Assistance

The Seeming spell can alter a person’s appearance to mask this and other cosmetic differences.

You have chronic acne on your face and upper body. Because many cultures view this as unsightly, you have a −(IE × 1/2) penalty on all Charisma (Persuasion) checks. The discharge within the pustules contains the following, which rupture frequently.
Generate Trait

function displayTrait() { const set = [ {range: [1], trait: 'Acid'}, {range: [2,8], trait: 'Blood'}, {range: [9], trait: 'Honey'}, {range: [10,12], trait: 'Oil'}, {range: [13,19], trait: 'Pus'}, {range: [20], trait: 'Venom'} ]; const randomNum = Math.floor(Math.random() * 20) + 1; let selectedTrait = ''; for (const item of set) { if (randomNum >= item.range[0] && randomNum <= item.range[item.range.length - 1]) { selectedTrait = item.trait; break; } } document.getElementById('trait').innerHTML = selectedTrait; }

• Acid. Acid leaks out of your skin at a rate of (IE) ounces per day. Your skin is not immune to this acid, so you have scars and need a way to constantly flush it out or collect it to keep it off your skin. If collected, a flask of 32 ounces equals one use as a weapon.
• Blood. Blood drains out of your skin at a rate of (IE) ounces per day. Because of this blood loss, you need to eat more to compensate, consuming an additional (IE) × ten percent to avoid exhaustion.
• Honey. A honey-like substance flows from your skin at a rate of (IE) ounces per day. While this substance is edible and tastes similar to honey, most people are reluctant to consume it, considering its source. Because of its sweet smell, it attracts insects and other animals, and if not properly cleaned, it will leave contacted substances sticky.
• Oil. An oil similar to lamp oil drains out of your skin at a rate of (IE) ounces per day. If collected, it can be used for lanterns and other practical uses, but if not collected or washed away consistently, it gets on your hands, clothes, and items, making it difficult to hang onto anything. Consequently, anytime you're handling an object during a tense situation (e.g., a weapon in combat), you must succeed on a DC 10 Dexterity saving throw to avoid dropping the object.
• Pus. A foul-smelling ochre pus flows from your skin at a rate of (IE) ounces per day. The smell gives you a −(IE) penalty on Dexterity (Stealth) and Charisma (Persuasion) checks. If collected, 32 ounces of the pus can be thrown at a target and cause the same effects to that target as a Stinking Cloud spell.
• Venom. A toxic substance leaks from your skin at a rate of (IE) ounces per day. You are not immune to this substance, so if not contained somehow, in any situation where you take damage that is not psychic or bludgeoning, you need to succeed on a DC 10 Dexterity saving throw with a −(IE) penalty to avoid getting it in a wound. A creature subjected to this poison must succeed on a DC 11 Constitution saving throw, taking 7 (2d6) poison damage on a failed saving throw, or half as much damage on a successful one.
  While referred to here colloquially as venom, this reflects real-life examples where an irritant or contagious liquid is expelled.

Real-world Examples

Polycystic Ovary Disease, Cushing Syndrome, Congenital Adrenal Hyperplasia, Androgen-secreting Tumors, Acromegaly, Apert Syndrome, SAPHO Syndrome, Behçet Syndrome, PAPA Syndrome

Assistive Options

Spending a week without significant stress can reduce the IE by 1.

Magical Assistance

Healing magic can be specifically applied to acne to remove it (although it will not remove scars) instead of restoring hit points, but it returns the next day. The Prestidigitation spell can clean the affected area but does not stop the discharge.

Generate Trait

function displayEntry() { const table = [ {range: [1,4], entry: 'Chronic Acne'}, {range: [5,10], entry: 'Skin Color Difference'}, {range: [11,13], entry: 'Keratin Distribution Difference'}, {range: [14,16], entry: 'Nails Difference'}, {range: [17,21], entry: 'Sweat Difference'}, {range: [22,28], entry: 'Blistering'}, {range: [29,43], entry: 'Hair Growth Difference'}, {range: [44,45], entry: 'Hair Material Difference'}, {range: [46,60], entry: 'Fissures'}, {range: [61,67], entry: 'Hyperelasticity'}, {range: [68,74], entry: 'Paresthesia & Phantom Pain'}, {range: [75,100], entry: 'Rash'} ]; const randomNum = Math.floor(Math.random() * 100) + 1; let selectedEntry = ''; for (const item of table) { if (randomNum >= item.range[0] && randomNum <= item.range[1]) { selectedEntry = item.entry; break; } } document.getElementById('entry').innerHTML = selectedEntry; }

The blood vessels in your skin constrict, leaving you feeling cold and numb. The area affected depends on IE as follows: 1, digits (fingers and toes); 2, extremities (hands and feet); 3, limbs (arms and legs); 4, whole body. You take an additional (IE) × 10 percent cold damage. If the trait is degenerative, it will eventually lead to Thrombosis and amputation.

Real-world Examples

Raynaud’s Disease, Scleroderma, Lupus, Vasculitis, Ehlers Danlos Syndrome

Assistive Options

Wrapping the affected areas in heavy insulating clothing for warmth will reduce the IE by 1 while worn.

Magical Assistance

Spells and magic items that provide resistance to cold damage reduce the IE by 1 while in effect. If you have immunity to cold damage through magic protection, you will still take (IE) × 5 percent of the original cold damage.

You are unable to get enough air, sometimes feeling a tightness in your chest, or you can’t take deep enough breaths. You have a −(IE) penalty on all saving throws against gas-based poison attacks and Constitution checks related to exertion. After three rounds of strenuous physical action such as melee combat, you must succeed on a DC 8 + (IE) Constitution saving throw or take one level of exhaustion until you stop the activity and rest for (IE)d10 minutes. Each round you continue, you need to succeed on an additional saving throw, and the DC increases by 1 each round. When traveling without a mount or vehicle, you cover (IE) × ten percent less distance. Travel in a low-oxygen area, like mountains, increases the IE by 1–2, depending on the elevation. Because you’re used to assessing your physical capacity and finding creative solutions to perform physical tasks, once per long rest, you can choose to roll a Strength, Dexterity, or Constitution check with advantage.

Real-world Examples

Anxiety, Asthma, Heart Arrhythmia, Anemia, Chronic Obstructive Pulmonary Disease, Cardiomyopathy, Congestive Heart Failure, Down Syndrome

Assistive Options

Some sitting, standing, and breathing exercises can help to fill the lungs more easily. If you use one or more of these techniques during a short rest, the IE reduces by one for 1d4 hours. Using these techniques consistently for a least three days will maintain the IE reduction for the whole day as long as you continue these exercises.

Hypertension does not normally have noticeable traits, but you are more susceptible to complications. Every 3d100 days, you must succeed on a DC 5 + (IE) Constitution saving throw. On failure, you develop one of the following complications or traits: Organ Failure, Blindness, Diabetes, Memory Loss, or Confusion. (Roll randomly or, because these will significantly affect your character, discuss them, and choose one.)

Real-world Examples

Hypertension

Assistive Options

Maintaining a healthy diet low in salt and limiting alcohol consumption gives a +1 bonus to the Constitution saving throw.

Your blood doesn’t clot in a typical way. You bruise easily and bleed excessively even from slight injuries. When you take bludgeoning damage higher than your Constitution modifier × your Proficiency modifier, you must succeed on a DC 10 + (IE) Constitution saving throw or experience Internal Bleeding. When you take slashing, piercing, or necrotic damage higher than your Constitution modifier × your Proficiency modifier, you must succeed on a DC 10 + (IE) Constitution saving throw or lose (IE) hit points at the start of each of your turns due to an open wound. Any creature can take an action to stanch the wound with a successful DC 8 + (IE) Wisdom (Medicine) check. You heal (IE) × 20% less hit points from a rest (minimum 1). If you have multiple traits, you may choose Arm Pain and Leg Pain as one or more of them.

Real-world Examples

Hemophilia

Assistive Options

First aid can usually stop bleeding, and ice can aid joint pain caused by internal bleeding around the joints.

Your blood does not have the hemoglobin associated with most people. A creature that drinks blood like a vampire or stirge that tries to drink yours must succeed on a DC 8 + (IE) Constitution saving throw on a successful bite attack or experience 2 (1d4) poison damage unless otherwise noted and does not receive the restorative benefits from the attack.

• Acid. Your blood is highly acidic. Every minute of exertion, such as combat, a walking forced march, or climbing, you need to succeed on a DC 5 + (IE) Constitution saving throw, increasing cumulatively by 1 every minute of exertion or take one level of exhaustion until taking a short rest. If collected, a flask of 32 ounces equals one use as a weapon. A creature successfully biting you takes 1d(IE) acid damage.
• Chlorocruorin. Your blood is green and processes oxygen better than usual, but you’re sensitive to cold environments. You can hold your breath an additional (IE) × 10 percent. You take an additional (IE) × 10 percent cold damage and have a −(IE) penalty on Constitution saving throws against extreme cold as outlined in official fifth edition sources. When wearing cold weather gear, you must still make this saving throw, although the cold weather gear grants advantage on the saving throw.
• Coboglobin. Your cobalt-based blood is colorless or amber yellow and does not retain oxygen as well. You are also highly susceptible to cold. You can hold your breath (IE) × 10 percent less than usual, and in low oxygen areas like high altitudes, you must succeed on a DC 8 + (IE) Constitution saving throw every hour or take one level of exhaustion until taking a short rest. You take an additional (IE) × 10 percent cold damage and have a −(IE) penalty on Constitution saving throws against extreme cold as outlined in official fifth edition sources. When wearing cold weather gear, you must still make this saving throw, although the cold weather gear grants advantage on the saving throw. You have a +(IE) bonus to saving throws against extreme heat as outlined in official fifth edition sources.
• Combustible. Your blood contains a volatile chemical combination that, when exposed to oxygen by taking piercing or slashing damage, combusts for 1 round, causing (IE)d4 damage to anyone it touches, including you and any creature that causes the damage with a claw or bite attack.
• Erythrocruorin. Your blood, which has a much higher iron content than usual, is much brighter red than is typical and allows you to process more oxygen at a time. You can hold your breath for IE × 10 percent longer than usual and have a +(IE) bonus to Constitution checks related to exertion. If successfully attacked by a creature that sucks blood, the creature gains an additional (IE) benefit from the bite attack and does not take poison damage.
• Hemerythrin. Your blood is colorless or violet, and you heal faster than usual, receiving a + (IE) × 10 percent (minimum 1) bonus to all healing magic, but you process oxygen less efficiently than typical, so you can hold your breath (IE) × 10 percent less than usual, and in low oxygen areas like high altitudes, you must succeed on a DC 8 + (IE) Constitution saving throw every hour or take one level of exhaustion until taking a short rest. You also have a +(IE) bonus to all saving throws against gas-based poison damage.
• Hemocyanin. Your copper-based blood is colorless or blue and operates best in low-oxygen or cold environments. You can hold your breath an additional (IE) × 10 percent. You have a +(IE) bonus to all saving throws against cold damage. You have a −(IE) penalty on saving throws against extreme heat as outlined in official fifth edition sources. In warm tropical environments, every minute of exertion, such as combat, a walking forced march, or climbing, you need to succeed on a DC 5 + (IE) Constitution saving throw, increasing cumulatively by 1 every minute of exertion or take one level of exhaustion until taking a short rest. Because your blood is colorless or nearly so, anyone attempting to stabilize you while you make death saving throws using first aid has a −(IE) penalty on their Wisdom (Medicine) check.
• Vanabins. Your blood color ranges from deep blue to yellow and uses oxygen extremely efficiently. You can hold your breath for IE × 10 percent longer than usual and have a +(IE) bonus to Constitution checks related to exertion. This increase in metabolism, however, requires more food, so you must eat (IE) × 50 percent more food than usual.
• Volatile Liquid. When your blood, which varies from colorless to yellow, is exposed to air, it instantly evaporates into a toxic gas. You are resistant to it but not immune. All within (IE) × 5 feet must succeed on a DC 8 + (IE) Constitution saving throw or take (IE)d4 poison damage.

Real-world Examples

Acidosis; (Found in animals) Hemerythrin, Vanabins, Chlorocruorin, Erythrocruorin, Hemocyanin

Assistive Options

Assistance for these blood types involve avoiding harmful environments when possible.

Magical Assistance

Magic that provides resistance to cold or fire damage will reduce the temperature sensitivities of blood types as applicable by 2 IEs.