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Edit : Yeah, and pickups such as batteries, pills and cards are allowed as well.
Doing it as The Lost felt like the easiest way for me. It feels like a regular run without shops.
No hearts whatsoever, no bombs, no coins.
It is possible with a lot of patience, Azazel is probably the easiest to use but you must get something to increase his range, like Brimstone, Tech, Ludovico (that's godly), Mom's Knife etc.
Just reset a lot until you find something useful in the first floor (play on Normal of course), and then give it a shot.
Also, don't pick up any item what spawns bombs, coins or gray hearts, they may spawn right on you thus making you fail the challenge.
Very useful is the book that gives you black hearts directly in the health bar, any HP-up you may find, anything that gives you more health or restores it to have room for errors, the path to Lamb is kinda long with few hearts.
I heard there's a seed or something that makes pickup disappear after a while, since they may spawn on the door blocking you. Search for it somewhere in the forum
Btw I found this challenge really hard, I always end up picking up something without paying attention... I'll just have to be 300% aware I guess...
Of course, it doesn't remove pickups instantly, they still take a little while to time out, but it does mean you can clear up rooms with many pickups without failing the challenge, which means you don't have to worry too much when going into previous rooms at least.
Difficulty wise it's not that much of a challenge to do provided you get a few bombs from items - the problem is that it's incredibly easy to accidentally pick up something you're not allowed to and instantly lose your chance at the achievement for that run.
Lost can't pick up red hearts, and free devil deals so no caring about my remaining hp.