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Wilderness: Starfish, Crown of Thorns, and Sea Star Punctures

Starfish, Crown of Thorns, and Sea Star Punctures Overview

Starfish, crown of thorns, and sea stars live throughout the subtropics and tropics. They are bottom dwellers, so any contact with a diver is accidental. Injury occurs from the spine and the venom injected from the spine. Crown of thorns have as many as 13-16 short, sharp spines that are up to 6 cm (over 2 inches) long.

Starfish, Crown of Thorns, and Sea Star Punctures Symptoms

  • Severe pain, itching, swelling, heat, and redness may occur with contact.
  • More severe reactions include numbness, tingling, weakness, paralysis, nausea, vomiting, joint aches, headaches, and cough.

Starfish, Crown of Thorns, and Sea Star Punctures Treatment

If medical attention is not readily available, the following guidelines are recommended in treating a puncture wound:

  • Immerse the affected area in water as hot as the person can tolerate for 30-90 minutes. Repeat as necessary to control pain.
  • Use tweezers to remove any spines in the wound because symptoms may not go away until all spines have been removed.
  • Scrub the wound with soap and water followed by extensive rinsing with fresh water.
  • Do not cover the wound with tape.
  • Apply hydrocortisone cream 2-3 times daily as needed for itching. Discontinue immediately if any signs of infection appear.
  • Apply topical antibiotic ointment (Bacitracin) 3 times per day if signs of infection, such as pus, redness, or heat, are present.

Oral antibiotics are usually recommended for infection.

  • Continue antibiotics for at least 5 days after all signs of infection have cleared.
  • Check for drug allergy prior to starting any antibiotic.
  • When outside, use sunscreen and wear protective clothing, such as a long-sleeved shirt, pants, and a wide-brimmed hat, while taking these antibiotics because certain antibiotics may cause sensitivity to the sun. 

Pain may be relieved with 1-2 acetaminophen (Tylenol) tablets every 4 hours or 1-2 ibuprofen (Advil, Motrin) tablets every 6-8 hours.

When to Seek Medical Care

  • Seek medical treatment as soon as possible.
  • Consult a doctor about treatment with available medications.

For More Information - Web Links

Great Barrier Reef Marine Park Authority (GMRMPA), CROWN-OF-THORNS STARFISH, All Stings Considered, First Aid for Crown-Of-Thorn Sea Star (Starfish) Punctures

MedlinePlus, Marine animal stings or bites


Media file 1: Unlike most starfish that are typically pentamerous, the crown of thorns starfish may have as many as 23 arms and a body disk of up to 60 cm in diameter. Photo courtesy of Dee Scarr.

Starfish Sting

Media type:  Photo

Media file 2: Detail of the crown of thorns starfish spines, which may grow to 6 cm in length. Photo courtesy of Dee Scarr.

Venomous Starfish

Media type:  Photo

Synonyms and Keywords

wilderness: starfish, crown of thorns, and sea star punctures, starfish punctures, crown of thorns punctures, sea star punctures, scuba diving, snorkeling

WebMD Medical Reference from eMedicineHealth

Reviewed by Cynthia Dennison Haines, MD on May 24, 2006

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