Pica Run

Pica Run is challenge #41. The goal is to defeat Isaac. This challenge is unlocked by defeating Mom's Heart 11 times and unlocking.

Strategy
The challenge is played as Isaac, who starts with, Marbles, and , resulting in 4 random trinkets spawned on the floor in the starting room. All item pedestals, including those ones from Devil Rooms, Shops, Libraries, etc., are replaced with trinket drops. It is, however, still possible to see a few item pedestals in this challenge.

Unlike its usual function, Marbles now causes Isaac to swallow his held trinkets every time he takes damage, rather than having a low chance of occurring. This allows building up a large collection of trinkets, quite easily making up for the lack of regular items. However, this has its downsides - some trinkets on their own or in combination with others can have undesirable or even disastrous results, such as wild teleportation or spontaneous explosions. If there is any uncertainty, looking up the trinket before committing to it by having it swallowed is recommended.

If you have a way to heal your red hearts, Devil Beggars and Blood Donation Machines can be extremely useful to swallow more trinkets while keeping your soul hearts and Devil room chance.

Certain Trinkets are much more valuable than others at the beginning of a run, especially since, Isaac's starting active item in this run, doubles the effects of most Trinkets. Since four Trinkets are given to you to start with, it may be useful to restart until you find one (or more) of the following:


 * Cancer - a reliable tears up.
 * Curved Horn - a massive damage up.
 * Crystal Key - gives more opportunities to charge Mom's Box, giving you more Trinkets.
 * Isaac's Fork - helps regain health lost from gulping trinkets.
 * Number Magnet - makes Devil Rooms more common.
 * Mother's Kiss - adds 2 more heart containers which are normally unobtainable.

Items can still be obtained through rerolling key pieces.

Trivia

 * Pica is a psychological disorder where a person experiences a compulsion to eat inedible objects and substances.