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1. Download any mod with the Steam Workshop (requires Afterbirth and Afterbirth+), it can be new visuals, new character(s), new item(s), new sound effects, whatever you want.
2. Go into the game and activate the mod(s).
3. Exit the game.
4. Re-enter the game.
5. Play the game like normal. If achievements are disabled (shown by a crossed out trophy), you're doing it right.
6. Press the ~ key, and a menu will show up. now you can mess around and find out how to give yourself items, spawn things, and more. When you want to close the menu, make sure you have nothing typed in and press enter.
Sure, with the console you can start with whatever items you want, but the cool thing about the challenge launcher was being able to restrict items.
I once made an "I'm Blue" challenge in Afterbrth with the custom challenge launcher ; play as Blue Baby with Blue Cap, Blue Map, Sad Bombs, and Tear Detonator, but the catch was that every item that wasn't mostly blue or grey (white to black) was restricted. I don't know if there's a way to limit the item pool with the console in AB+, but even if there is...
I'd also like to save these files. Restricting about 200 items takes a lot of time. Even inputting 4-5 starting items takes time, if you want to do it a few times over. I'd really like a mod that does all these things again and lets me save my edits.