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A red pentagram necklace.
Isaac grows horns on his head and as with all damage increase items, if total damage exceeds 5, the tears become red.
Increases Damage by 1 and also increases the chance for a Devil Room to appear by 20%. There is also a chance of this item appearing twice and it will stack with the previous Pentagram, granting more damage and a additional increase of 10% for finding the devil room.
- The pentagram is often associated with Satanic ritual and the devil, which is probably why having the item increases the chance of finding a Devil Room.
- A pentagram is a style of a shape called a pentacle, a star circumscribed by a circle. If the star is upside down it attracts evil, which is why it is associated with demons and evil.
- The pentragram loosely resembles Satan's face, with the top two points being his horns, and the middle containing his eyes and mouth.