Brimstone: Two Brimstone shots are fired, without an increase in charge time.Blood Clot / Chemical Peel: Every second row of tears has increased damage.The maximum amount of tears per volley that can be reached by combining and/or duplicating 20/20, The Inner Eye, Mutant Spider and The Wiz is 16, or 20 with the Keeper.Unlike other multiple shot items like Mutant Spider or The Inner Eye, 20/20 does not reduce the rate of fire.Isaac fires two tears at once, one from each eye.Eye of the Occult: When used with a laser attack (such as Brimstone), Lil Brimstone will not automatically fire as it would with Marked.
King Baby / Marked: While firing, Brimstone will be charged automatically and fired immediately upon full charge, the beam will now target the nearest enemy/crosshair. Hemoptysis + BFFS!: The curse causes the beam's damage to be increased to 13 damage per tick. 
Enemies who die to the Brimstone beam under the curse will damage and spread the curse to nearby enemies.
Hemoptysis: Enemies hit by the sneeze will gain a curse that increases the damage the Brimstone beam deals to 8 damage per tick. Baby-Bender: Brimstone beams will home in on enemies. Familiars that follow behind Isaac have a certain priority in how close their position is to him over other familiars, with Lil Brimstone having 3rd priority. Collecting three items from this set will transform Isaac into a three-faced version of himself. This item belongs to the Conjoined set. 
Unlike Brimstone, Lil Brimstone can start charging up a beam while still firing the previous one. The beam deals 3 damage per tick and can strike an enemy up to 8 times, for a total of 24 damage. The beam deals 3.5 damage per tick and can strike an enemy up to 9 times, for a total of 31.5 damage. It needs to be charged up it will not fire if Isaac is shooting a steady stream of tears. 
Grants a familiar that fires a thin Brimstone beam.
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