Starting Items: 

• 3x Bombs

• Voodoo Head

• Fragmented Card trinket

Gameplay: 

• The first Item Room entered is guaranteed to have Belly Button, but it does not spawn an extra trinket

• Always has Curse of the Labyrinth, which can stack with other curses

• Trinkets that spawn additional rooms may be earned under particular circumstances:

  • Blue Key - Enter a Super Secret room for the first time

  • Silver Dollar - Pick up The Polaroid

  • Bloody Crown - Pick up The Negative

  • Wicked Crown - Enter a Devil room on the Womb

  • Holy Crown - Enter an Angel room on the Womb

Starting Items: 

• Mine Crafter

• Blue Key trinket

• A Cracked Key will spawn at the start of each floor

• Punch Card pocket active

Gameplay: 

• Cannot enter the Boss Room until they have explored all of the rooms on the floor (excluding the Boss Room and Ultra Secret room)

  • Rooms that don't appear on the map (such as red rooms) may be used to circumvent this requirement, as entering one counts toward the number of rooms explored

• Can enter Boss Rush and The Blue Womb regardless of the amount of time taken to get there.

Starting Items: 

• Balaam's Black Book

• Wooden Cross trinket

Starting Items: 

• Gulped Dice Bag trinket

• Mending pill

Gameplay: 

• Cannot obtain trinkets

• All Red Heart containers are turned into Black Hearts

• Always has 100% chance to receive an Angel or Devil room

  • Devil Deal items no longer cost health, but taking any item in a Devil Room adds one broken heart

Starting Items: 

• Stitches and 9 Volt

• Gulped Crow Heart trinket

Gameplay: 

• Items resembling animal parts, bones, and other voodoo items have a higher chance of appearing, and may spawn outside of their normal pool

Starting Items: 

• Heartbreak

Gameplay: 

• Soul Hearts and Red Heart containers are automatically removed

  • Bone Hearts can be gained, but they cannot drop on the floor. Any spawned this way are randomized into a different heart type.

• Devil Deals do not remove hearts, but taking any item in a Devil Room immediately removes all other pedestals (even if they do not have a cost)

Starting Items: 

• Missing No. and a random Active Item

Gameplay: 

• At the beginning of each floor, receives a random passive item; any held active item or trinket is then rerolled (in addition to the effects from Missing No.)

• Item pedestals inside of Treasure Rooms are replaced with nickels

Starting Items: 

• Corrupted File pocket active

• 'M trinket

Gameplay: 

• Entering a new room has a small chance to cause corruptions, particularly by glitching item pedestals and setting enemies on fire

  • If an item pedestal is glitched in a special room (excluding Shops and Devil Deals), the player will be unable to leave until they take at least one item from the room

Starting Items: 

• Sanctum Mandatum and Holy Light!

• Fragmented Card trinket

Gameplay: 

• All Red Heart containers are turned into Soul Hearts

• Starts with a 100% chance to receive Angel Rooms

  • Skipping the first Angel Room grants a small chance to receive a Devil Room on the next floor

  • Entering an Angel Room prevents Devil Deals from appearing for the remainder of the run

  • Taking any item in an Angel Room immediately removes all other item pedestals

Starting Items: 

• Ludovico Technique

• Pilfered Reliquary pocket active item

Gameplay: 

• All Soul Hearts are automatically removed

• Cannot gain Flight