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http://bindingofisaac.wikia.com/wiki/Boss_Challenge_Room
These rooms can only be entered if the player is at full health (or the equivalent of full health, made up with Soul Hearts). It is also possible to enter the challenge room without full health if it borders a secret room and you blow up the wall in the secret room that leads to the challenge room; however, you can't use bombs to exit the Challenge Room until you have finished it. Having the XRay Vision Item makes it possible to leave back into the Secret Room, though.