- Isaac wears what appears to be a burnt mask with a permanent smile.
- The player receives five bombs.
- All explosions the player is hit by will now heal for one red heart.
- If used with ???, no soul hearts are generated, but he retains immunity to explosions.
- This also makes the player immune to Mom's, Satan's, and other enemies' stomp attacks, making those fights much easier.
- Makes the player immune to hellcampfires' shots.
- Pretty effective with any explosive attacks, especially infinite ones, like Dr. Fetus and Ipecac, since it gives player unlimited healing ability. Can be effectively used with Blood Donation Machine.
- Pyromaniac + Kamikaze is a game breaking synergy, as you can infinitely regenerate health by pressing the space key.
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