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Diablo IV
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Blood Moon Breeches has no quest, no reputation track, and no guaranteed unlock. In Diablo IV, it is a Necromancer-only Ancestral Unique pants that drops from the endgame loot pool, so the fastest way to land it is to farm high Torment content quickly and feed boss echoes into Duriel, King of Maggots, the confirmed target-farm source. If you searched for the item under its French name, Jambières de la lune de sang, it is the same piece of gear.
This is not a generic survivability slot. Its identity is curse-driven summon support. The unique effect gives your Summoning Skills a 7–10% chance to randomly inflict Decrepify or Iron Maiden, and crucially, curses now apply from all of your Summoning Skills, not just minion attacks. On top of that, you deal 50–60% increased Critical Strike Damage to enemies affected by your Curses. In plain terms: your army spreads curses for you, and your crits hit harder against everything it touches.
The inherent affixes lean straight into that fantasy. A current roll carries +9–11% Critical Strike Chance, +2–3 Curse Skill Ranks, +1–2 Golem Mastery, and +1–2 Hellbent Commander. That stat line makes it a clear chase item for minion-heavy, curse-based Necromancers and a weak pick for anything else. If you run a direct-cast or sacrifice build with few minions, this is not your pants slot — see our Lord of Hatred Necromancer build for a setup that actually uses it.
The percentage ranges shift between patches, so trust your in-game tooltip for exact numbers. The mechanics above are stable across every current database.
Blood Moon Breeches drops from the normal Unique pool, and Ancestral Uniques only appear in high-tier endgame content. Get into Torment-level difficulty first. If you are still below that threshold, stop hunting the pants and build a stable farming loop instead.
The biggest mistake here is pushing a difficulty that makes every run slow. Unique hunting is a volume problem. Ten clean runs at a Torment you finish fast beat three painful runs at a higher tier where you spend half your time kiting elites. Kill speed wins.

If you want one named source, use Duriel, King of Maggots. He is the most consistently confirmed target-farm source for Blood Moon Breeches across databases. Andariel, Maiden of Anguish is a second documented source, so if you have materials for both, run both — but treat Duriel as the priority.
Structure your session around feeding summoning materials into repeated boss kills. Boss echoes turn your time into concentrated high-value drops instead of hoping a random chest hits the right Unique pool. If your build shreds single targets, lean hard into this. If you clear packs better than bosses, spend the first half of the session farming materials, then commit them in one block of repeated summons. Our best Duriel farm route applies here too — the same loop feeds both items.
The Lord of Hatred crafting system gives you a real shortcut. The Horadric Cube’s “Upgrade to Unique” recipe takes a common (white) pants base and Primordial Dust and outputs a random unique pants of the same type — and Blood Moon Breeches is in the Necromancer pants pool. It is not a guaranteed target craft; every attempt is an RNG roll within the category. But if you are sitting on spare dust, it is faster than waiting on a drop. Full recipe details are in our Horadric Cube recipes guide.

When you have no boss materials and no dust, switch to content that generates the most item rolls per minute. Blood Moon Breeches can drop from any high-Torment source, so favor dense enemies and frequent rewards:
This stacks two goals at once: you are always generating general Unique rolls while building toward the most reliable named target-farm lane. That beats grinding one dungeon for hours and hoping the pants appear.
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Do not auto-equip it just because it is orange. Blood Moon Breeches gives up a custom pants slot, so it has to earn the space. It is strongest when your Necromancer already runs Skeletal Warriors, Mages, and a Golem, wants curses active constantly, and benefits from Curse ranks, Golem Mastery, and Hellbent Commander scaling. In that build it saves you manual curse casts and raises uptime on curse-based synergies.
If your build is mostly direct-cast damage with minimal minions, the curse proc rarely fires and the pants lose most of their value. Chase this for a summoner Necromancer, full stop.

Farm Blood Moon Breeches like any high-value endgame Necromancer Unique: stay in Torment content you can clear fast, feed boss echoes into Duriel, King of Maggots (with Andariel as a backup), and burn spare Primordial Dust on Horadric Cube pants rolls. Then only commit it to your build if your Necromancer is genuinely built around minions and curses — that is the only profile where its 7–10% curse proc and 50–60% crit-against-cursed bonus actually pay off.