Is blood orb of ch'thon useless?

I’ve never seen a single end game build focused on it, and it has some massive downsides :
elemental damage converted into chaos damage, but chaos damage has no DoT so the DoT damage would need itemized for as well (most elemental damage skills have a dot component).

-50 HP/s regen (which is actually higher, -65/s on the mythical version, though the mythical version has the possibly more useful acid -> vitality conversion in addition).

The actual stats on it also aren’t particularly mindblowing - they’re not awful, but not worth using without a decent active.

Vit Cabalist

I don’t remember if anyone came up with anything impressive with elemental to chaos conversion before or after AoM, but acid to vitality can have some use

http://www.grimdawn.com/forums/showthread.php?t=64083
http://www.grimdawn.com/forums/showthread.php?t=66237

Chaos purifier looks like it would be very good with it, huge -resist with demon fire, word of pain and thermite mine

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afaik there’s quite a few niche builds that use it, just because people don’t post them doesn’t mean they don’t exist.

This was my favourite build before AoM , my quickest killer in Ultimate .

http://www.grimdawn.com/forums/showthread.php?t=47227

I’ve not tried in AoM still sitting at lvl 85 , I have so many other characters to level .

It has its uses, like making phantasmal blades (almost, stupid pierce) vit/chaos or bloody pox full vit/decay. And don’t forget converting the acid spray proc, quite useful for a vit build, or changing tainted eruption to a vit decay nuke (biggest one you can get in the game too).