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Trinkets are a new kind of passive item that were introduced in the expansion The Binding of Isaac: Wrath of the Lamb.

They provide passive bonuses, but only one can be held at a time. The collectible item Mom's Purse allows two trinkets to be kept at once. The held trinket is displayed in a slot in the upper left portion of the screen.

Trinkets can be found:

After completing a room
In normal and golden chests
From Fortune Telling Machines
In the Top Secret Room
Dropped when picking up the item Box
Dropped from a blown-up Slot Machine
Re-rolled from another pickup with the D20
Dropped by the Bum Friend
Dropped by the Book of Sin (needs confirmation)
After defeating Mom (Polaroid)

They are mainly found in Fortune Telling Machine but they also have a rare chance of spawning after room is completed, from normal and golden Chests, blowing up slot machines etc. A guaranteed trinket will drop from the Box when it is found.

List of Trinkets

Name & Image	Effect	Info
???'s Soul	Gives you a familiar that looks like Brother Bobby and floats slowly around the room on a pattern similar to The Peeper, shooting long-range spectral homing tears. If you have other familiars, they may follow ???'s Soul instead of Isaac.	Unlocked by completing The Chest with ???.
Ace Of Spades	Improves chances of finding Tarot and Suit Cards.	Holding this items will give a small boost to the chances of finding suit cards: 2 of hearts, 2 of diamonds, 2 of spades, 2 of clubs and the joker card.
Bloody Penny	Gives a 50% chance to drop a 1/2 heart when money is collected.	Unlocked by completing Cathedral with Samson. Effective trinket for bloodbank gambling, often the penny dropped from a bloodbank will give a 1/2 heart allowing a "free" roll. Works well with IV Bag.
Burnt Penny	Gives a 50% chance to drop a bomb when money is collected.	Unlocked by completing the Large Marge challenge.
Cain's Eye	When starting a floor, 25% chance to get the The Compass effect for the duration of a floor.	Unlocked by completing The Chest with Cain.
Cancer	Decreases Tears Delay by 2. (see Tears on stats pages for calculation)
Child's Heart	Increases the chance of receiving hearts from drops (clearing rooms, enemy drops, etc.)
Counterfeit Penny	Gives a 50% chance of increasing the value of every coin pickup by one. Can be found in Golden Poop.	Unlocked by completing the Isaac Was Good Today challenge
Cursed Skull	If Isaac's health is brought down to 1/2 of a red heart, Isaac is then teleported to the last room he was in. If Isaac only has Soul Hearts as health, or only has 1/2 of a red heart and soul hearts, he will be teleported upon taking damage, as well as teleporting ??? every time he takes damage.	If you are brought down to a 1/2 heart near the end boss battle (Example: You kill Monstro II but his flies brought you down to a 1/2 heart) you will have to complete the boss battle again. You only get one reward for killing the boss since the first battle was not finished.
Curved Horn	Increases damage.	Unlocked by completing The Cathedral with Judas
Eve's Bird Foot	Gives a chance of spawning a Dead Bird familiar when attacking an enemy for that room only.	Unlocked by completing The Chest with Eve.
Flat Penny	Gives a 50% chance of spawning a key upon collecting a penny. Also may rarely spawn a Golden Key.
Fish Head	Attack flies spawn every time Isaac gets hit.	Unlocked by completing the Lord of the Flies challenge
Goat Hoof	Increases speed.
Isaac's Head	Gives the player Isaac's severed head as familiar. It is similar to Brother Bobby, but it has piercing tears.	Unlocked by completing The Chest with Isaac.
Isaac's Fork	Clearing rooms may heal Isaac by 1/2 of a heart (10% chance).
Judas' Tongue	Items in the Devil Room only cost 1 heart. Soul heart trades still cost 3 Soul hearts. Only works if you have the trinket before revealing the Devil Room.	Unlocked by completing The Chest with Judas.
The Left Hand	Replaces all normal chests with Red Chests. Gold chests are affected as well.	Unlocked by defeating Ultra Pride.
Liberty Cap	25% of giving Isaac a random passive effect from Mushrooms as well as its corresponding visual effect upon entering a room. Bug v1.48: Can also randomly add The Compass effect.	Possible mushrooms: Mini Mushroom, Odd Mushroom (Large), Odd Mushroom (Thin). When playing as ??? will generate a spirit heart when you gain the health up effect from Odd Mushroom (large). This spirit heart does not disappear when you exit the room.
Lucky Toe	Increases the chance to get a drop after clearing a room. Although the Luck stat also influences this, it does not actually increase the Luck stat.	Unlocked by Completing the 7 Years Bad Luck challenge.
Maggy's Faith	Gives an eternal heart at the start of every floor.	Unlocked by completing The Chest with Maggy.
Match Stick	Increases the chance of receiving bombs from drops (clearing rooms, enemy drops, etc.)
A Missing Page	5% to induce The Necronomicon's effect upon taking damage.
Mom's Pearl	Increase the chance of red heart pickup becoming a soul heart when spawned (approximately by 10%). This effect stacks with the item Mitre
Pinky Eye	10% chance to fire a poison tear.	There's a possibility to fire poisonous bombs with Dr. Fetus.
The Polaroid	If Isaac's HP is 1/2 heart or less or takes damage that would reduce his HP to 1/2 heart, he will receive a brief shield similar to the Book Of Shadows. This effect ignores soul hearts. The effect always works for ???. Holding The Polaroid while opening the big chest at the end of the Cathedral will allow you to continue to The Chest. Since 1.4, it is always dropped by Mom (provided it is unlocked).	Unlocked by completing Cathedral six different times. You may use the same characters for all six completions.
Push Pin	10% chance to fire a spectral tear and piercing tear.
Red Patch	When hit, you can randomly gain additional damage as if you used the Razor Blade.	Isaac loses his skin for the duration of the room. If Isaac has flight, loses body as well (visual effect similar to Transcendence).
Rusted Key	Improves the chance of Keys and Golden Chests dropping after clearing a room.
Safety Cap	Improves drop rate of pills.
Samson's Lock	Have a chance of increasing damage each time Isaac kills an enemy for the current room. When damage is maxed, Isaac and his tears turn red.	Unlocked by completing The Chest with Samson. This is the same effect as Bloody Lust, but maxes damage more quickly. When used in combination with Bloody Lust, damage will be maxed even more quickly.
The Tick	When entering boss rooms, bosses spawn with 15% less health; and one heart of your health bar gets restored. Cannot be swapped out for another trinket.	Adds a tick to Isaac's head. When fighting The Fallen, once he splits in two, both copies will have their health reduced as well. Might be disadvantageous when playing with Eve: The player entering a boss room in the Whore of Babylon state will fight the boss in the character's regular state. The player will be unable to access The Chest without the use of Mom's Purse, as the nature of this trinket makes it impossible to pick up The Polaroid.
Umbilical Cord	When Isaac's health is brought to one half of one heart, a Little Steve familiar spawns.	Applies only for the current room, making it mostly useless unless you can maintain low red hearts all the time.