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

Medically Reviewed by Jennifer Robinson, MD on August 16, 2022
Written by WebMD Editorial Contributors
2 min read

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.

Puncture symptoms include:

  • Severe pain
  • Itching
  • Swelling
  • Heat
  • Redness

More severe reactions include:

If medical attention is not readily available, use the following guidelines for 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 salt 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.

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

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