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Ghost Pepper is a passive item added in Afterbirth †.
- Shooting tears sometimes spawns a fire similar to Red Candle, damaging enemies and destroying shots it comes into contact with.
- Use of pooping items (Re-Lax, The Poop, etc) causes fires to appear alongside the poop.
- The chance of spawning fire is not affected by luck.
- BrimstoneTears are replaced by a laser beam that pierces through all enemies and obstacles in its path and deals high damage. Can only be fired after a short charge-up period.: The flames can still shoot from Isaac while holding the fire button.
- Dr. FetusTears are replaced by bombs that benefit from bomb-enhancing effects and slide a fixed range after being fired.: Fires can be spawned while firing bombs.
- Epic FetusIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote.: Fires can be spawned while moving the crosshair.
- Explosive Diarrhea: Will spawn fire upon use.
- HaemolacriaTears are now fired in an arc. Upon hitting the floor, an obstacle, or an enemy, they burst into many smaller tears in all directions. Increases tear delay.: Occasionally spawns fire while still shooting normal tears.
- IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.: Fires are spawned as normal and can be hit by Ipecac tears, making this especially dangerous with a multi-shot ability.
- Mom's KnifeIsaac's tears are replaced by a knife that pierces enemies, can travel through obstacles, and can hurt enemies while Isaac is holding it. Holding down the fire button before firing increases its range and power.: The flames can still shoot from Isaac while holding the fire button.
- Monstro's LungIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.: The flames can still shoot from Isaac while holding the fire button.
- The PoopSpawns a pile of poop where the character is standing and knocks nearby monsters back. May yield pickups like regular poop.: Fire will appear behind Isaac.
- TechnologyReplaces tears with a piercing laser with unlimited range.: Will occasionally spawn a fire. The lasers will not douse the flames.
- Tech XTears are replaced with laser rings that pierce through enemies and deal damage to enemies within them. Can be charged to increase the size of the ring.: Will occasionally spawn firing while charging lasers. Laser rings will not douse the flames.
- TrisagionTears are replaced with piercing white blasts of light.: Will occasionally spawn a fire while firing beams. Fires damage is not reduced.
- Wait What?Isaac farts, sending out rock waves.: Will spawn fire upon use.
- 20/20Grants double shot./ The Inner EyeGrants triple shot but decreases tears./ Mutant SpiderGrants quadruple shot but decreases tears.: Will only spawn one fire.
- Anti-Gravity-2 Tear Delay. Tears float in position until firing ceases, after which they will fly off in the direction they were shot in.: When holding down the fire button, when fire spawns it will be almost immediately put out by the clumps of tears.
- Blood ClotIncreases damage by 1 and range by 5 for tears fired from the left eye.: No effect on range or damage of flames.
- Compound FractureIncreases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle./ Cricket's BodyGrants -1 Tear Delay and reduces Range. When tears hit an object or deplete their range, they spawn 4 smaller tears, whose Range and Damage scale with Isaac's./ The ParasiteIsaac's tears split in two when they hit something.: Occasionally, spawns fire that will not split.
- Homing tears: Flames will not be homing.
- IncubusA demonic familiar that follows Isaac and shoots tears identical to Isaac's in terms of damage, range, fire rate, and effects.: Will not spawn fire, making the item useless as Lilith.
- LachryphagyIsaac's tears decelerate as they travel. Upon stopping or hitting an obstacle, they burst into 8 tears in all directions. Tears can be fired into other tears to feed them, increasing their damage.: Feeding tears will quickly douse the flames.
- The Ludovico TechniqueInstead of firing tears, Isaac controls one floating tear that hover over obstacles. This tear deals constant damage when held in place over an enemy.: Fires created from Ghost Pepper will destroy the tear and cause it to respawn on Isaac.
- A Lump of CoalThe more distance tears travel, the more damage they will do.: Affects normal tears but no effect on fire.
- Pop!Replaces Isaac's tears with eyeballs that can bounce off of each other. The eyeballs are not limited by range, and will instead dissipate when they stop moving or when hitting an enemy or obstacle.: Eyeballs tears quickly douse flames.
- ProptosisTears start out massive with high damage, and then shrink down and become weaker over a short range.: Flames will not lose damage or shrink as they travel.
- Soy MilkTears shrink and do much less damage, but fire in very rapid succession.: No effect on frequency or damage of flames.
- SprinklerUpon use, spawns a sprinkler that rotates and fires tears.: The sprinkler will not spawn flames.
- The item is a play on words of a pepper called the ghost pepper which is arguably one of the world's hottest peppers.