Scuba Diving: Starfish (Sea Star) and Crown of Thorns Puncture Wounds: Starfish (sea star) and crown of thorns puncture wounds are bottom dwellers, so contact with scuba divers or snorkelers is usually by accident. Symptoms of a starfish or crown of thorns puncture wound include pain, bleeding, and inflammation at the injury site. Severe reactions include nausea, vomiting, weakness, numbness, tingling, joint aches, headaches, cough, and in rare cases paralysis. Treatment methods include cleaning the area, removing any spines if possible, antibiotic cream, and oral antibiotics if infection occurs.