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

Written by WebMD Editorial Contributors
Medically Reviewed by Jabeen Begum, MD on September 01, 2026

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 allergies 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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