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Trigger warning — this fiend description contains fears of age, body dysmorphia, and hypochondria, so if you have concerns about content like that, I suggest you give this creature a miss
Ichkoh Sahkil
The Herald of Treacherous Flesh (CR 7); gerascophobia & hypochondriasis — fear of failing of the flesh
Home Planes: Ethereal / Xibalba; Nether
Alignment: Neutral Evil
The ichkoh [ish-KOE] embody the fear we all have deep down of getting old, only they magnify it to a truly awful degree. They manifest as grotesque and decrepit abominations whose forms have deteriorated, with wizened features, matted hair and oh, the body of a fetid cockroach and enormous legs of a spider. Their most horrifying feature of all though, instead of an insectile face, they have the visage of a leering malevolent humanoid. With a little effort, the ichkoh can meld their faces to resemble those of your loved ones—in the throes of illness or decay, naturally. Their goal is to remind cutters that their own flesh will one day betray them too, failing when they need it the most.
The bodies of these putrid fiends writhe and decompose before your very eyes. They seem to have been woven from filthy hair in various states of decay, and patches of this scabrous fur constantly fall away and regrow, creating a perpetual shower of decomposing skin-dust that follows the vile creatures wherever they scuttle.
Ichkoh sustain themselves on the fear of bodily failure and physical decline. The creatures particularly savour fears related to growing old and physically deteriorating—gerascophobia. If you ever worry about losing your strength, mobility, mind, or youth, then you’d make a delicious starter for an ichkoh. Their main course however is hypochondriasis—obsessive anxiety about one’s health and with minor symptoms indicating serious illnesses. The ichkoh amplifies fears of cancer, degenerative diseases, and the slow corruption of internal organs, and are able to fool creatures into believing their own bodies are falling apart. This literally causes their victims physical harm. They whisper suggestions about extreme diets, dangerous cosmetic procedures, excessive exercise regimens, or substance abuse—anything that promises to halt or reverse the aging process, but actually accelerates physical decline.
While ichkoh typically remain invisible as they wage their campaign of torment, there are tell-tale signs that an informed cutter may be able to detect. Unexplained hair and dust accumulates in drains and corners, for anything shed by the sahkil becomes visible. Mirrors and reflective surfaces may become inexplicably dirty or distorted. Foul odours manifest without an identifiable source. Increased insect activity may be noticed, particularly cockroaches displaying unusual behaviour patterns.
Ichkoh themselves are more obsessive than most sahkil, for once they latch onto a particularly fearful or physically proud victim they might invisibly pursue their favourite mortal for years, tormenting them all the while with fears about their health—the sahkil aims to drive its victim to take their own lives. They particularly seek out athletes or performers just past their peak, aging beauties, and anyone whose identity depends heavily on their physical capability or appearance. The ichkoh feeds upon the belief that the greatest horror is not of death itself, but of the slow betrayal of the body that carries you inevitably towards it.
Source and Stats: Bestiary 6 [PF1e] p243
Other Sources: Jon Winter-Holt. Canonwatch: The sahkil are a fabulously horrid type of fiend from Pathfinder lore, who make a great addition to the Ethereal Plane and Planescape lore generally. The Creature Codex has done an awesome job of expanding the number of sahkil massively too, and I’ve included all their creations here. Organising the sahkil into three sub-types based on their hunting style was my idea, because the list was unwieldy and their names are (deliberately) hard to remember, and this splits them up into bite-sized chunks.