Infection from Crown of Thorns Puncture


A DAN Member recently called for help following a puncture wound on his index finger from a crown of thorns the previous day. At the time of the injury he was offshore on his own boat. He proceeded to a point where he could take a fast day boat trip to the nearest hospital.

He had soaked his hand in hot water, which provided some relief, but he woke with a blue and swollen hand with further swelling and inflammation moving up his arm.

He was taking amoxycillin. The DAN doctor advised that he needed to proceed to a medical facility as soon as possible to be evaluated, and receive antibiotics and a possible tetanus shot.

After surgical removal of a small piece of spine which was still lodged in his finger, he spent the night in the hospital while receiving antibiotics. When DAN spoke to the member he was feeling much better, and the pain and swelling were subsiding.

The member recovered well and was able to return to his boat.

The following extract from an article in Alert Diver magazine by Joseph Becker, M.D., and Paul Auerbach, M.D., M.S, discusses treatment for starfish and sea urchin punctures.


Starfish are common bottom-dwelling animals and contact by divers is usually accidental. The crown-of-thorns starfish is a species with particularly potent venom. The thornlike spines on the starfish’s surface are sufficiently sharp and stout to pierce a thick wetsuit. The spines release a toxin that can cause significant stinging pain as well as systemic symptoms such as nausea and vomiting.

Immediately immerse starfish puncture wounds in hot water to tolerance. A rescuer should test the temperature to avoid scalding the injured person. If the spines can be easily grasped without fragmentation, they should be removed and the wounds then washed with soap and water. Wounds should not be closed but may be dressed and bandaged. Puncture wounds are especially prone to infection, so treating physicians will consider antibiotic therapy, particularly if damage to deeper tissues is suspected or if the victim has an impaired immune system.

Sea urchin punctures may be treated similarly, although it is often difficult to achieve thorough removal of all spine fragments. The long, thin and brittle spines are likely to break off inside wounds, making identification and extraction challenging. Purple or black discoloration of the skin at the puncture site does not necessarily mean that a fragment is still embedded in the tissue. This “tattoo” may result from dye that has rubbed off the surface of the spine. If the discoloration persists after 24-48 hours, a retained spine fragment should be suspected. Spines or fragments penetrating deeply into tissues or joints

Read the full article: Marine Envenomations – Invertebrates

Author: DAN World

DAN® is the world’s leading dive safety association.

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