Abstract
Information is lacking on parental recognition and management practices for dermatophytosis, a common childhood infection associated with increasing antifungal resistance. We analyzed data from a nationwide survey of US mothers with children < 18 years living at home, using chi-squared tests to compare respondents who indicated they would treat dermatophytosis with over-the-counter corticosteroids versus those who would not. Among the 306 respondents, 47% correctly identified ringworm and 63% misattributed erythema migrans as ringworm; 17% said they would try an over-the-counter corticosteroid cream for suspected dermatophytosis, a practice more frequently reported among respondents who were non-Hispanic Black (29% vs. 11%), Hispanic/Latino (10% vs. 8%), and non-Hispanic multiracial (16% vs. 11%) (p = 0.009) and who had a high school education or less (45% vs. 27%, p = 0.032). Our study emphasizes the challenges of visually diagnosing dermatophytosis and the importance of early healthcare evaluation to ensure accurate diagnosis and proper treatment.
Keywords: child health, corticosteroids, dermatophytosis, fungal drug resistance, surveys and questionnaires
1 |. Introduction
Dermatophytosis (ringworm) is a common childhood infection receiving renewed attention because of emerging antifungal-resistant infections [1–3]. Parents are often the first to respond to childhood rashes, but information is lacking on US parental recognition and management practices. We analyzed data from a nationwide survey of US mothers with children < 18 years living at home.
2 |. Methods
CDC contracted Porter Novelli (PN), a communications firm specializing in social marketing and public health research, to assist with survey development, recruitment strategy, and fielding. We used PN View Moms survey data (https://styles.porternovelli.com/pn-view-panels/). The survey was conducted in English during July 22–25, 2025, using quota sampling based on region, income, and race/ethnicity to achieve a nationwide sample.
Participants reported demographic information, answered questions on treatment and prevention, and attempted to identify images of ringworm rashes among a series of photos of various types of rashes (Table 1, Figure S1). They also indicated actions they would take if they suspected their child had ringworm, factors prompting care seeking, and ringworm prevention measures.
TABLE 1 |.
Survey respondents’ demographic characteristics (N = 306).
| Response | No. (%) |
|---|---|
| Age group, years | |
| 18–29 | 62 (20) |
| 30–39 | 97 (32) |
| 40–49 | 105 (34) |
| 50+ | 42 (14) |
| Region | |
| Northeast | 49 (16) |
| Midwest | 64 (21) |
| South | 113 (37) |
| West | 80 (26) |
| Marital status | |
| Married or living with partner | 208 (68) |
| Single, separated, divorced, widowed | 98 (32) |
| Own or rent dwelling | |
| Own | 167 (55) |
| Rent | 127 (42) |
| Live with others at no cost | 12 (4) |
| Highest level of formal education completed | |
| High school or less | 93 (30) |
| Some college | 105 (34) |
| Bachelor’s degree or higher | 108 (35) |
| Employment status | |
| Working full or part time or student | 215 (70) |
| Not working | 91 (30) |
| Total household income before taxes | |
| Less than $75,000 | 165 (54) |
| $75,000 or more | 141 (46) |
| Race/ethnicity | |
| African/African American/Black, non-Hispanic | 44 (14) |
| Asian, non-Hispanic | 7 (2) |
| Hispanic/Latinx | 26 (8) |
| Multiple race, non-Hispanic | 35 (11) |
| Other race/ethnicity, non-Hispanic | 7 (2) |
| White, non-Hispanic | 187 (61) |
| Community type | |
| Urban | 76 (25) |
| Suburban | 160 (52) |
| Rural | 70 (23) |
| Political affiliation | |
| Republican | 82 (27) |
| Democrat | 88 (29) |
| Independent | 87 (28) |
| Something else | 9 (3) |
| Not sure | 29 (9) |
| Decline to answer | 11 (4) |
| Childrens’ ages | |
| Infant 1–3 weeks | 4 (1) |
| Infant 4–7 weeks | 7 (2) |
| Infant 2 months to toddler (2 months to 2 years) | 74 (24) |
| Preschool-aged (3–5 years) | 92 (30) |
| Elementary school-aged (6–10 years) | 136 (44) |
| Middle school-aged (11–13 years) | 101 (33) |
| High school-aged (14–17 years) | 114 (37) |
| Total children in household | |
| 1 | 114 (37) |
| 2 | 102 (33) |
| 3 | 48 (16) |
| 4 or more | 42 (14) |
Traditional survey response rates are inapplicable, as response links remain accessible to everyone in the study sample pool. To facilitate rapid fielding, no restrictions on the number of clicks were implemented, so quotas often fill before all respondents could participate. In total, the survey recorded 880 clicks, with 306 completed surveys, 126 incomplete responses, and 448 terminations or no responses. We analyzed the number and frequency of responses for completed surveys. Chi-squared tests compared respondents who indicated they would (vs. would not) treat dermatophytosis with over-the-counter corticosteroid creams.
3 |. Results
Among the 306 respondents, the median age was 38.5 years (interquartile range: 31.0–45.0). The largest percentage were from the South (37%), followed by the West (26%) (Table 1). Most were non-Hispanic White (61%), with 14% non-Hispanic Black, 11% non-Hispanic Multiracial, and 8% Hispanic/Latino. The highest educational level was a bachelor’s degree or higher for 35%, 34% with some college, and 30% with a high school education or less.
When shown images of common childhood rashes, 47% correctly identified ringworm and 63% misattributed erythema migrans as ringworm; fewer misattributed eczema/psoriasis (25%), hives (3%), or chickenpox (2%) as ringworm (Table 2). When asked what they would do if they believed that their child had ringworm, 82% indicated they would contact their healthcare provider or pediatrician; 31% would try an over-the-counter antifungal cream, 17% would try an over-the-counter corticosteroid cream, and 13% would try natural remedies. Potential over-the-counter corticosteroid cream use (vs. non-use) was more frequently reported among respondents who were Black (29% vs. 11%), Hispanic/Latino (10% vs. 8%), and multiracial (16% vs. 11%) (p = 0.009) and who had a high school education or less (45% vs. 27%, p = 0.032); other comparisons were non-significant (Table S1).
TABLE 2 |.
Survey respondents’ answers to questions about ringworm (N = 306).
| No. (%) | |
|---|---|
| Of the rashes pictured, which are images of ringworm? | |
| A (hives) | 10 (3) |
| B (ringworm) | 145 (47) |
| C (eczema or psoriasis) | 75 (25) |
| D (erythema migrans) | 193 (63) |
| E (chicken pox) | 5 (2) |
| None of these [EXCLUSIVE] | 1 (0) |
| I do not know [EXCLUSIVE] | 20 (7) |
| If you thought your child had ringworm, what would you do? | |
| Treat it with over-the-counter antifungal cream | 96 (31) |
| Treat it with over-the-counter steroid cream (e.g., cortisone) | 51 (17) |
| Treat it with a natural remedy (e.g., tea tree oil, apple cider vinegar) | 39 (13) |
| Contact your healthcare provider/pediatrician | 250 (82) |
| Search online for advice | 74 (24) |
| Search using ChatGPT or another AI service for advice | 26 (8) |
| Ask a friend or a family member for advice | 55 (18) |
| Wait and see if it gets worse before acting | 10 (3) |
| I do not know what ringworm is [EXCLUSIVE] | 3 (1) |
| None of these [EXCLUSIVE] | 3 (1) |
| Which of the following would make you more likely to seek medical care for your child’s ringworm? | |
| The ringworm rash is large or spreading | 240 (78) |
| The ringworm rash is very itchy | 164 (54) |
| The ringworm rash is on their scalp or face | 158 (52) |
| The ringworm rash does not improve with home treatment | 196 (64) |
| The ringworm rash looks infected (redness or swelling) | 225 (74) |
| None of these [EXCLUSIVE] | 12 (4) |
| What do you do to prevent ringworm in your child(ren)? (n = 303) | |
| Educate my child about avoiding contact with infected people or animals | 157 (52) |
| Keep my child’s clothing and other personal items clean and dry (shoes, gym bags) | 189 (62) |
| Discourage walking barefoot in public places (pools, locker rooms) | 169 (56) |
| Have my child take a shower after sports practices, games, or matches | 187 (62) |
| Discourage sharing clothing, towels, sheets, or other personal items | 167 (55) |
| Make sure my child’s skin is kept clean and dry | 184 (61) |
| Make sure my child’s fingernails and toenails are kept short and clean | 158 (52) |
| I am not concerned about ringworm [EXCLUSIVE] | 25 (8) |
| I do not try to prevent ringworm in my children [EXCLUSIVE] | 7 (2) |
Respondents indicated they would be most likely to seek medical care for their child’s ringworm if the rash was large or spreading (78%) or appeared infected with redness or swelling (74%). Other triggers included lack of improvement with home treatment (64%), substantial itchiness (54%), and rash location on the scalp or face (52%). For prevention, the most frequently reported strategies were keeping children’s clothing clean (62%), showering after sports (62%), and keeping skin clean and dry (61%).
4 |. Discussion
In this nationwide survey of US mothers, under half of respondents (47%) correctly identified dermatophytosis from an image, highlighting the difficulty of visually diagnosing rashes and the importance of seeking early healthcare for accurate diagnosis and treatment. Nearly one-fifth (17%) reported they would use an over-the-counter corticosteroid for ringworm, which can worsen fungal infections [4]. This response was more frequent among Black respondents and those with lower educational attainment, groups that might be disproportionately affected by dermatophytosis [5–7].
Reassuringly, most respondents (78%) said they would consult a healthcare provider or pediatrician if a rash was spreading or appeared infected; however, only about half would seek care if it was on the face or scalp. Localized, non-severe tinea faciei can often be treated with topical antifungals, but tinea capitis requires evaluation by a healthcare provider and treatment with systemic antifungals to ensure hair shaft penetration [1, 4]. Delayed care seeking could potentially contribute to prolonged illness, complications, and preventable transmission.
5 |. Limitations
Important limitations include the lack of diversity in survey images, lack of assessment of participants’ understanding that “ringworm” is fungal, the opt-in and English-language–only design limiting generalizability, and the small sample size precluding multivariable analyses.
6 |. Conclusion
Our findings suggest that focused education might help parents determine when it is necessary to seek care for suspected dermatophytosis and could emphasize the importance of avoiding over-the-counter topical corticosteroids for such conditions.
Supplementary Material
Additional supporting information can be found online in the Supporting Information section. Figure S1: Images used for survey about ringworm in children. Table S1: Characteristics of participants reporting they would vs. would not treat ringworm with an over-the-counter (OTC) corticosteroid cream.
Acknowledgments
We thank Meghan Lyman, MD, Dallas J. Smith, PharmD, MAS, and Mitsuru Toda, PhD for reviewing this manuscript. ChatGPT (OpenAI) was used for language editing of this manuscript; all intellectual content is the sole responsibility of the authors. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.
Footnotes
Conflicts of Interest
The authors declare no conflicts of interest.
Consent
This activity was reviewed by CDC, deemed research not involving human subjects, and was conducted consistent with applicable federal law and CDC policy (see e.g., 45 C.F.R. part 46; 21 C.F.R. part 56; 42 U.S.C. §241(d), 5 U.S.C. §552a, 44 U.S.C. §3501 et seq.).
Data Availability Statement
The data used in this analysis cannot be shared publicly because the CDC licensed the data from Porter Novelli. The data are owned by Porter Novelli, a third party, and the authors do not have permission to share the data. The data underlying the results presented in the study are available from Porter Novelli (https://www.porternovelli.com/).
References
- 1.Hill RC, Caplan AS, Elewski B, et al. , “Expert Panel Review of Skin and Hair Dermatophytoses in an Era of Antifungal Resistance,” American Journal of Clinical Dermatology 25, no. 3 (2024): 359–389. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Caplan AS, “Notes From the Field: First Reported US Cases of Tinea Caused by Trichophyton Indotineae—New York City, December 2021–March 2023,” MMWR. Morbidity and Mortality Weekly Report 72 (2023): 536–537. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Palepu S and Treat JR, “Presumed Trichophyton Indotineae Infection in Children: A Call for Heightened Clinical Awareness,” Pediatric Dermatology 42 (2025): 1097–1098. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Caplan AS, Gold JAW, Smith DJ, and Ely JW, “Diagnosis and Management of Tinea Infections,” American Family Physician 112, no. 4 (2025): 382–392. [PubMed] [Google Scholar]
- 5.Hennessee IP, Benedict K, Dulski TM, Lipner SR, and Gold JA, “Racial Disparities, Risk Factors, and Clinical Management Practices for Tinea Capitis: An Observational Cohort Study Among US Children With Medicaid,” Journal of the American Academy of Dermatology 89, no. 6 (2023): 1261–1264. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Mirmirani P and Tucker LY, “Epidemiologic Trends in Pediatric Tinea Capitis: A Population-Based Study From Kaiser Permanente Northern California,” Journal of the American Academy of Dermatology 69, no. 6 (2013): 916–921. [DOI] [PubMed] [Google Scholar]
- 7.Kruithoff C, Gamal A, McCormick TS, and Ghannoum MA, “Dermatophyte Infections Worldwide: Increase in Incidence and Associated Antifungal Resistance,” Life 14, no. 1 (2024): 1. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data used in this analysis cannot be shared publicly because the CDC licensed the data from Porter Novelli. The data are owned by Porter Novelli, a third party, and the authors do not have permission to share the data. The data underlying the results presented in the study are available from Porter Novelli (https://www.porternovelli.com/).