The Shell Game Beggar can be given a Coin, which will make him show a Heart, Key, Bomb, Coin , or Skatole under a skull. The skulls are then shuffled and one of them can be chosen. There is a 33% chance for the chosen skull to have the Pick Up previously shown, regardless of which skull the item was initially under. If chosen correctly, 2 (2-4 if Coins) of the Pick Up will drop, and the game can be played again until Isaac runs out of Coins, or if Skatole is won, which will cause the Beggar to disappear. If chosen incorrectly, an Attack Fly will come out of the skull.
- The chance for the skull to have a pickup inside can be increased to roughly 55% with the Lucky Foot item. The Luck Stat is completely unrelated, however.
- There is a 1/13 chance of Skatole being shown in the skulls, but the chances of winning it are the same as the others.
- The Skatole can be re-rolled into another item by using The Dice.
- The pickups can be replaced by their counterparts, such as Keys being replaced by Golden Keys, Bombs being replaced by Troll Bombs, Hearts being replaced by Eternal Hearts, etc.
- Blowing up the Shell Game Beggar with a Bomb will cause him to drop several random Pick Ups and increase the chance of spawning a Devil Room by 35%. This does not stack with other Beggars blown up on the floor. However, it will stack with other chances, such as activating the Book of Belial or taking no red heart damage on the boss fight.
- The Arcade cannot be exited while the Shell Game is in progress.
- The skulls shown are that of a Host.
| Isaac • Magdalene • Judas • Cain • Eve • Samson • ??? • Eden • Lazarus • The Lost|
|Babies • Beggar • Devil Beggar • Key Beggar • Shell Game Beggar • Bomb Bum • Shopkeeper • Others|
|Old Man Keeper|