Steven's severed head.
When picked up, makes a smiling tumor grow on the side of Isaac's head.
Increases Damage by 1.
If Little Steve has already been acquired, Steven will drop this item instead. There is also a chance to get Steven without Little Steve.
Using The Dice on Little Steve after the Steven boss fight will have a small chance to change it to Steven.
- The item is a reference to one of Edmund McMillen's games, Time Fcuk, along with the boss Steven himself and the item Little Steve.
- In Time Fcuk, the majority of the game takes place inside a box, which may explain why the item can be found in golden chests.