How this tier list is ranked
Impact is how much one trinket changes a run. A trinket that lifts damage or health sits at the top.
Reliability comes next. An effect that fires without a condition is worth more than one that needs a rare trigger.
Cost is the downside you accept by holding the trinket. A strong effect with a hard cost drops a tier.
This list ranks decision value. It answers one question. How often does this trinket earn its slot?
The tier list at a glance
| Tier | Trinket | Why it ranks there |
|---|---|---|
| S | Cancer | Cuts the damage you take from each hit, saving hearts across a run. |
| S | Curved Horn | Adds a chunk of damage with no setup, a plain offense pickup. |
| S | Lucky Toe | Raises your luck stat, which lifts drops, pills and item effects. |
| S | Maggy’s Faith | Grants an extra red heart container for the whole run. |
| S | The Left Hand | Turns chests into red chests, adding more items or devil chances. |
| A | Cain’s Eye | Reveals nearby secret rooms as you walk, saving bombs on each floor. |
| A | Bloody Penny | Drops a half heart on some coin pickups, so money doubles as a heal. |
| A | Mom’s Pearl | Upgrades some heart drops into soul hearts, making healing go further. |
| A | Store Credit | Gives one free shop item, a direct discount on a good floor. |
| A | Swallowed Penny | Drops a coin whenever you take damage, refunding part of the cost. |
| A | Match Stick | Improves your devil room odds, adding more deals across a run. |
| B | Wiggle Worm | Gives your tears a wavy path that covers more ground in a crowd. |
| B | Tape Worm | Sends your tears in a straight, fast line against small enemies. |
| B | Flat Penny | Adds a chance for a key on some coin pickups, opening more doors. |
| B | Burnt Penny | Adds a chance for a bomb on some coin pickups, paying for secret rooms. |
| B | Fish Head | Spawns a fly when you take damage, adding a small helper to the fight. |
| B | Petrified Poop | Raises the drops from poop, a winner on a poop-heavy floor. |
| C | Tick | Heals you at the boss door but trims your health ceiling. |
| C | Broken Ankh | May revive you as a different character, an unreliable swap. |
| C | Ring Worm | Gives your tears an erratic path, which makes aiming harder. |
| C | Child’s Heart | Adds heart drops only where hearts already fall. |
| C | Faded Polaroid | May charm an enemy when you are hit, but rarely when you need it. |
S-tier trinkets
These trinkets change a run on their own. Each one is worth a slot from the first floor.
Cancer cuts the damage you take from each hit. The effect is quiet, but it saves hearts across a run.
Curved Horn adds a chunk of damage with no setup. It is a plain offense trinket for any build.
Lucky Toe raises your luck stat. Higher luck lifts drops, pills and many item effects.
Maggy’s Faith grants an extra red heart container. The buffer helps a run that keeps taking chip damage.
The Left Hand turns chests into red chests. A floor can then pay out more items or devil chances.
A-tier trinkets
These trinkets solve a common problem. Each one pays off on most floors you visit.
Cain’s Eye reveals nearby secret rooms as you walk. It saves bombs on every floor you cross.
Bloody Penny drops a half heart on some coin pickups. Money then doubles as a slow heal.
Mom’s Pearl upgrades some heart drops into soul hearts. The upgrade makes your healing go further.
Store Credit gives one free shop item. On a floor with a strong shop, that is a real pickup.
Swallowed Penny drops a coin whenever you take damage. A mistake then refunds part of its cost.
Match Stick improves your devil room odds. More deals across a run add up to more items.
B-tier trinkets
These trinkets help in the right room. Their value depends on your build and the floor ahead.
Wiggle Worm gives your tears a wavy path. The curve covers more ground in a crowd.
Tape Worm sends your tears in a straight, fast line. The shape helps against small, distant enemies.
Flat Penny adds a chance for a key on some coin pickups. More keys open more locked doors.
Burnt Penny adds a chance for a bomb on some coin pickups. The extra bombs pay for a secret room.
Fish Head spawns a fly when you take damage. Each hit adds a small helper to the fight.
Petrified Poop raises the drops from poop. The trinket earns its slot on a poop-heavy floor.
Trinkets to avoid
These trinkets are not useless. Their cost is high for a run that cannot spare the room.
Tick heals you at the boss door but trims your health ceiling. A low-health build should pass on it.
Broken Ankh may revive you as a different character. The swap is unreliable and changes your run.
Ring Worm gives your tears an erratic path. The wobble makes precise aiming harder.
Child’s Heart adds more heart drops, but only where hearts already fall. A dry floor gives it nothing to work with.
Faded Polaroid may charm an enemy when you are hit. The charm rarely lands at the moment you need it.
Best trinkets for beginners
A new player should hold trinkets that add health or luck. Cancer and Lucky Toe both fit that rule.
Cancer trims the damage of each hit. Lucky Toe improves the drops you find on the way down.
Maggy’s Faith adds a heart container. More health forgives the early mistakes every new player makes.
Swap the trinket as you learn each floor. A plain stat lift beats a tricky effect you cannot use yet.
Best trinkets for a thin run
When health is low, a trinket that heals or blocks damage is worth the slot.
Bloody Penny and Mom’s Pearl both add healing. Cancer cuts the damage before it reaches your hearts.
Swallowed Penny turns each hit into a coin. The money can buy a heart at the next shop.
Avoid the Tick when your hearts are few. Losing your health ceiling narrows every later floor.
What to remember
A trinket is a small slot with a large effect. The right one can carry a run from the first floor.
Read the cost before you swap. An effect that looks strong can trim your health or your aim.
Hold the trinket that answers your run now. A plain stat lift often beats a clever effect you cannot trigger.
Next: Item tier list and Trinkets and consumables.