Bullous pemphigoid is a chronic autoimmune blistering disease characterized clinically by tense bullae that develop on normal or erythematous skin. Bullous pemphigoid is associated with autoantibodies to two hemidesmosomal proteins, BPAG1 (230 kD) and BPAG2 (180 kD). The localized form of BP is an unusual variant that occurs in 5∼30% of the patients. A 58-year-old man who had been suffering from right hemiplegia since 2006, presented with multiple tense bullae localized on both arms and hands. Direct immunofluorescence test showed linear deposition of IgG and C3 along the basement membrane zone. The antibodies against the recombinant NC16a-domain of BP180 were positive by ELISA and immunoblotting using epidermal extract of normal human foreskin demonstrated that the patient’s serum reacted with only BP180 antigen. Here, we report a case of localized bullous pemphigoid on both upper extremities in a hemiplegic patient predominantly on the opposite side to the hemiplegia.