I’m at work and I’m in “all of your stupid ideas are good” mode so
The “Clown” template can be added to any living creature and is transferred by either eating a part of a Clown or being bitten by one.
The Clown diseases are Cackling Cold and Polka Pox, the former being spread through Clown bites, the latter through the consumption of Clown tissue.
Cackling Cold: Injury - bite. Onset: 2d4 days. Frequency: 1/day. Effect: 1d3 Charisma drain. Cure: none. This infection can only be cured through magic, requiring the caster to beat the Clown’s infection DC (10+Clown’s hit die+its Charisma modifier).
As the subject’s Charisma gets lower and lower, their skin becomes increasingly pale and then begins changing to an unnatural white. Scars and injuries begin to fade away. Their nose runs almost constantly, and they’re wracked with a persistent, wet cough that imposes a -6 penalty to all Stealth checks. In addition, each time they observe the injury or misfortune of another being, or themselves, they must succeed on a DC 15 Will save (Cha based) or be overcome with laughter, as Hideous Laughter, for one round.
Their nose begins to puff up, and their nose and mouth begin turning red, though this often goes unnoticed due to the symptoms. At late stages (4 or less Charisma) the subject’s hair–all hair–begins falling out. Once a subject’s Charisma is drained to 0, rather than falling unconscious they stand and seek out somewhere lonely, dark, and quiet and curl into a tight ball. If allowed to, their whole body becomes wrapped in a tight cocoon of a cotton-candy-like substance over the course of four hours. This candy deals 1d4 slashing damage to anyone that makes unprotected contact with it. Each cocoon has 40 hit points and no hardness, repairing itself by 10 points each hour if it is damaged. If destroyed, the infected subject will mindlessly seek to make another one unless its ability drain, or the disease, is cured.
This cocoon remains in place for 1d3+1 days, at which point the subject “hatches” out, all ability damage and drain, negative levels, lethal, and nonlethal damage cured, and they gain the Clown template.
Polka Pox: Ingested. Onset: 2d6 days. Frequency: 1/12 hours. Effect: 1 Cha drain. Cure: 3 successful saves. Any attempt to magically cure Polka Pox must succeed a caster level check versus a DC of (10+½ the Clown’s hit die+the Clown’s Cha modifier) or the attempt merely undoes 5 points or Charisma drain.
The Charisma drain manifests as large, colorful spots forming on the skin, roughly 3 to 4 for every 1 point of drain. These spots can be hardly noticeable at first as they manifest on the back or the legs, but eventually they become impossible NOT to notice. These spots manifest even if the subject changes their appearance through magical or mundane means, makeup flaking away 1 hour after being applied.
The subject becomes increasingly manic as their Charisma is drained, gaining a +1 to melee attack rolls, Initiative checks, and Dexterity-based skill checks, but they are easily distracted and irritable, imposing a -2 penalty to all Wisdom-based skill checks and saving throws, as well as ranged attack rolls, and an additional -4 penalty to Concentration checks.
Once their Charisma is drained to 3 or less, they fall into the same trance as someone infected with the Cackling Cold and undergoes the same transformative process, though it takes 1d6+1 days instead.
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