It’s a bad day to be an adventurer when you have to fight leprosy giants.
Ten feet tall, pale, and covered in sores, ash giants are a degenerate species molded by the devastated lands around them. Likely hill, stone, or wood giants originally, ash giants have long since been warped—the Bestiary 3 suggests by “disruptive magic, unearthed deep elements, or alien technology that fell calamitously from the sky”—beyond all recognition. Where other giants tap into runes or natural abilities, ash giants spread disease. Where other giants have animal and even magical mounts, ash giants befriend giant vermin. And while ash giants are not evil per se, their sense of humor can be as deadly as the oversized weapons they bear.
In Golarion ash giants dwell in a number of places, the blasted land of Numeria being the most obvious example. Should you be a fan of D&D settings, Eberron’s Mournland and anywhere associated with the Known World/Mystara’s Radiance could be a home to these creatures (not to mention the entire Forgotten Realms, whose middle name might as well be Calamity, or the blighted Underdark of 4.0’s Chained God, Torog). And should you be lucky enough to own the Book of Vile Darkness, ash giants could find powerful allies in that tome’s cancer mages and vermin lords…
Adventurers seek out an old friend who has been consigned to a leper colony. When they reach the remote tropical island, they find all is not as it should be. The lepers are slaves, many of the “hospital attendants” are ash giants, and the ministering friars spend more time exploring the nearby cyclopean ruins than tending to the sick.
Since their spine dragon “god” died (see The Inner Sea World Guide for spine dragon stats), a tribe of ash giants has been adrift. One band wandered off and inadvertently triggered a talking metal monolith. The monolith generates a field that repels the ash giants’ vermin servitors, so they seek humanoids they can force to serve the monolith’s ever-more insistent commands.
There is plague in the stews. A virulent form of leprosy has swept up from the docks through Dogtown and the Closes all the way to Basilisk Row. A promoter has imported ash giants to fight for him in the arena, and since he is protected by disease via magic, he cares not who dies—just so long as the giants are able to wield their enormous weapons for him in the Pit. He doesn't know a tribe of gremlins has discovered the unused keep where he is hiding the giants. The fey and the brutes get along famously thanks to their grim senses of humor, and the gremlins are engineering a jailbreak.
—Pathfinder Bestiary 3 126
Hey Welcome to Night Vale fans: Episode 50 came out this week, and it was written with help from Ashley Lierman of “Summer Reading Program” fame. I happen to know Ash is awesome (I dated her sister many moons ago, so I am contractually obligated to say that, but it’s true) so I hope you check out that episode.