Typically, Skull items will not be destroyed when hit by a blast. Instead, the panel will flip onto another tile. In some games, an option can be set to allow them to be destroyed.
As a "bad" item, in some games if a "diseased" player collects a regular item, the Skull will be expelled and flip onto another tile.
If a "diseased" player touches another player, one of two things can happen, depending on the game: the other player will also get the same disease, or the disease will be transferred over to the other player.
Typically, if a player has a disease for long enough, the item will simply disappear. However, in some games, the effects of the Skull will last for the rest of the match.
Each game that has a Skull item has a set of possible diseases that players can get from that item. This set varies. The following is a list of some of the common diseases:
- Rapid Pace Disease (駿足病) - The player moves extremely fast.
- Slow Pace Disease (鈍足病) - The player move extremely slow.
- Diarrhea (ゲリ) - The player continuously sets bombs when possible.
- Low Power Disease (不能病) - The player's bombs explode at minimum blast radius (1 tile from origin).
- Constipation - The player is unable to set bombs.
- Change (チェンジ) - The player switches spots with a different, random player.
- Fire - First seen in Bomberman 64, the player is set on fire and becomes invincible and deadly to touch. After a while, the player dies if they have not won the battle.
- Baron Bombano has the ability to generate a Skull item, which will flip onto the field.
- Witch Bomber actively seeks to pick up Skull items in the Battle Mode of Bomberman World.