The clinical and laboratory findings in pediatric mycosis fungoides- Can elevated blood eosinophil levels be related to the type of mycosis fungoides?

The clinical and laboratory findings in pediatric mycosis fungoides- Can elevated blood eosinophil levels be related to the type of mycosis fungoides? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The clinical and laboratory findings in pediatric mycosis fungoides- Can elevated blood eosinophil levels be related to the type of mycosis fungoides? Tubanur Çetinarslan, Beyza Türe Avcı, Hayrünnisa Arslan, Aylin Türel Ermertcan, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8228742/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma, however; it is rare in children. MF may mimick AD with laboratory findings such as elevated blood eosinophil levels and high immunoglobulin E (IgE) levels. Previous studies have demonsrated a positive correlation between the eosinophil levels and the advanced stage of adult MF. We aim to investigate the clinical presentation, treatment modalities and responses in pediatric MF patients and compare the laboratory parameters of children with MF with the healthy controls. A total of 29 pediatric MF patients and 29 healthy controls, were included. All patients were diagnosed with stage IA. Hypopigmented MF was the most common variant (62.06%), followed by folliculotropic (27.58%). Narrow band-UVB was the most commonly treatment method. LDH was significantly higher in the patient group MF patients (p =0.001). There was a significant difference in frequency of patients with elevated blood eosinophil levels according to MF type (p =0.013), elevated eosinophil levels was found in 66.7% of hyperpigmented MF, 37.5% of folliculotropic MF, and 6.7% of hypopigmented MF. Elevated blood eosinophil levels, which we found more frequently in children with MF than in healthy individuals in our study, is not clear if it is related with the prognosis or disease severity in pediatric MF patients. In our study, the MF type with the lowest frequency of patients with elevated blood eosinophil levels was hypopigmented. We assume that the elevated blood eosinophil levels in children is also associated with MF as in adult patients. However, the relationship between elevated blood eosinophil levels, which is suggested to be a poor prognosis indicator in adults, and prognosis of childhood MF is unknown, and prospective studies are needed on childhood MF. mycosis fungoides pediatric atopy elevated blood eosinophil levels atypical mycosis fungoides Figures Figure 1 Figure 2 Introduction Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma (CTCL) in the general population ( 1 ). It is very rare in childhood, accounting for approximately 5% of cases ( 2 ). MF lesions are pruritic, and the severity of itching usually increases as the stage of the disease progresses. Various hypotheses have been proposed regarding the cause of pruritus in MF. Guglielmo et al. ( 3 ) reported that pruritus in MF is mainly associated with Th2-related cytokines. Interleukin-4 (IL-4), in cooperation with IL-33, induces IL-31 production, which represents a key mediator in the pathogenesis of itch. IL-31 is produced by IL-4–stimulated CD4⁺ Th2 cells, mast cells, and dendritic cells. An alternative hypothesis is the presence of underlying atopy in MF patients ( 4 – 7 ). On the other hand, there are conflicting results regarding the risk of CTCL in patients with atopic dermatitis (AD) ( 4 – 6 ). MF may mimick AD with laboratory findings such as elevated blood eosinophil levels and high immunoglobulin E (IgE) levels ( 8 ). According to Guglielmo et al. ( 3 ), this increase in eosinophil counts and IgE levels results from a shift toward a Th2-dominant immune response driven by cytokines such as IL-5 during disease progression. Moreover, previous studies have demonsrated a positive correlation between the eosinophil levels and the advanced stage of MF ( 9 , 10 ). Since MF is very rare in pediatric population, studies evaluating laboratory results in children with MF are limited. In this study, we aimed to investigate the clinical, laboratory and histological findings, treatment outcomes in children with MF in a tertiary centre in Turkey. We also compared the lactate dehidrogenase (LDH) levels, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), complete blood count (CBC) and leukocyte profiles in pediatric patients with MF and healthy children. Materials and Method This retrospective study was performed in Dermatology and Venereology Department of Manisa Celal Bayar University in Turkey The study protocol was approved by the Local Ethics Committee of the university (approval date 12/02/2025 and nr 20.478.486 /2878). Demographic, clinical and laboratory data, and treatment outcomes of pediatric patients with MF and laboratory data of healthy controls were recorded. NLR was obtained by dividing neutrophil count by lymphocyte count and PLR was obtained by dividing platelet count by lymphocyte count. The neutrophil-to-lymphocyte ratio (NLR) was calculated individually for each patient using absolute neutrophil and lymphocyte counts, and mean ± standard deviation was subsequently reported. Laboratory data including hemoglobin, white blood cell (WBC), neutrophils, lymphocytes, monocytes, eosinophils, basophils and platelets' counts, red blood cell distribution width (RDW), mean corpuscular volume (MCV), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and LDH levels were compared between MF patients and healthy controls . Study Group MF patients who were under the age of 18, applied to Manisa Celal Bayar University Hospital Dermatology Outpatient Clinic, were included. The diagnosis of MF was confirmed clinically and histopathologically in all patients. Patients with nonspecific immunosuppression (such as liver and renal diseases, diabetes mellitus, malnutrition, malignancy), patients using systemic immunosuppressive agents, patients with acute and/or chronic infections, patients with concomitant chronic inflammatory diseases, including AD were excluded. Five patients were excluded from the study owing to concomitant comorbid conditions. Treatment outcomes were classified as no clearance (persistent lesions), partial clearance (documented improvement but not complete clearance) and total clearance (complete remission). As control group, healthy children applied to Manisa Celal Bayar University Hospital Dermatology Outpatient Clinic under the age of 18 were recruited for this study. All included controls had no previously known cardiovascular, metabolic, inflammatory, or neoplastic diseases and acute and/or chronic infection during laboratory analysis. Descriptive data were expressed as mean ± SD, numbers and percentages. Student's t-test and one-way ANOVA were used to compare continuous data. Student's t-test and Pearson's chisquared test were used to compare categorical variables. A p value of < .05 was considered statistically significant. Results A total of 29 patients (11 females, 37.9%; 18 males, 62.06%), and 29 healthy controls (17 females, 58.6%; 12 males, 41.3%), were included (Table 1). The mean age at diagnosis was 8.79 ± 4.72 years (range 2-17) in MF patients and 8.69±5.05 years (range 1-16) in healthy controls. No significant difference was observed between the MF patients and healthy controls in terms of age and gender (Table 2). Neutrophil count was significantly lower in MF patients (p < .001). LDH levels, eosinophil, lymphocyte and monocyte counts were significantly higher in the MF patients (p=0.001, p=0.008, p =0.001 and p=0.044, respectively) (Table 2). There was a significant difference in the frequency of patients with elevated blood eosinophil levels according to MF type (p=0.01), elevated blood eosinophil levels was found in 66.7% of hyperpigmented MF, 37.5% of folliculotropic MF (Fig.1), and 6.7% of hypopigmented MF (Fig.2). NLR and PLR were investigated according to MF type, however, no significant difference was found (p=0.303 and p=0.92) (Table 3). All patients were in stage 1A and treated with NB- UVB. Systemic involvement was investigated using laboratory examinations including CBC, chemistry and LDH, and imaging methods (sonography of lymph nodes and chest X-ray). Phototherapy (NB- UVB) was the most common treatment method (72.4%, 21/29) Among these, 18 patients were between 2 and 14 years of age, and 3 patients were adolescents aged 15 to 18 years,while the remaining patients (27.6%, 8/29) were managed with various topical agents including topical corticosteroids, bexarotene gel, and calcipotriol ointment. Mean treatment durations were 11.5±3 months in hyperpigmented MF, 11±4.2 months in hypopigmented MF, and 10±3.4 months in folliculotropic MF (FMF). According to MF types, no significant difference was found (p=0.79). In addition, no significant difference was observed in treatment response according to MF type (p=0.67). Complete cure was observed in all patients with hyperpigmented MF; 70% of patients with hypopigmented MF, and 50% of patients with FMF. No relapses were observed among our patients during follow-up, and those who achieved complete remission are being closely monitored for potential recurrence. No significant difference was found in LDH count according to MF type (p=0.51). LDH levels were found to be normal in all patients with hyperpigmented MFs and high in 42% of FMFs (n=3) and high in 30.8% of hypopigmented MFs (n=4). Discussion MF is the most common form of CTCL in both adults and children ( 11 ).Hypopigmented form is reported as the most common type of MF in children ( 11 – 15 ). In our study, consistent with the literature, hypopigmented MF was the most common type, followed by folliculotropic MF. Although FMF ( 16 ). Based on the study by Tomasini et al.( 16 ), we reviewed our eight FMF patients to determine whether they could be classified as early or advanced FMF. In that study, early-stage FMF was defined by follicle-centered, cone-shaped hyperkeratotic (spiky) papules without conventional MF plaques or tumors, and by histopathologic features fulfilling the WHO–EORTC criteria for early FMF. According to these definitions, our all FMF patients exhibited features consistent with early-stage FMF. MF lesions are pruritic, and the severity of itching usually increases as the stage of the disease progresses. Approximately 86% of our patients experienced mild pruritus, which improved with symptomatic treatments. The absence of treatment-resistant itching may be associated with the fact that our patients were in the early stage of the disease. Especially in geriatric individuals and/or patients with adult-onset AD, the distinction of AD from MF becomes important. Various hypotheses have been proposed regarding the cause of pruritus in MF lesions. While early stages of MF lesions exhibit a predominant Th1 inflammatory microenvironment, it changes to a T helper 2 (Th2)-dominated environment in advanced stages ( 17 ). T2 inflammation is mediated by various cells including Th2 cells, eosinophils, basophils, mast cells (MCs) and IgE producing B cells ( 18 ). MCs release several itch mediators, primarily histamine. Misery et al found no difference in the number of MCs in the skin of MF patients with or without itching and suggested that antihistamines do not appear to be effective in treating MF itch ( 19 ). On the other hand, eosinophils are also one of the main cells that play a role in the itch mechanism and release several chemokines including IL-31 that is thought to be involved in itching in MF ( 20 ). IL-31 is released from CD4 + Th2 cells as well as eosinophils ( 21 , 22 ). In both AD and CTCL, an increased levels of IL-31 in serum and in the skin, have been reported ( 23 – 25 ). This situation raises the question of whether there is an atopic diathesis in MF patients ( 7 ). Moreover, a correlation between serum IL-31 levels and the disease stage of CTCL, have been reported ( 25 ). However, Malek et al.( 23 ) did not show difference on IL-31 levels between pruritic and non-pruritic patients with CTCL.. Furthermore, Olszewska et al ( 8 ), showed significantly higher serum IL-31 levels in both AD and CTCL patients than in healthy controls, however, significantly higher IL-31 serum level was shown in AD than CTCL. Moreover, they reported a positive correlation between the IL-31 serum level and pruritus severity in AD patients, however not in CTCL. They suggested that IL-31 does not play a role in the pruritus in CTCL and it can be attributed to downregulation of IL-31 due to suppression of the benign T-cells by the dense dermal infiltrate of malignant T cells in advanced-stage CTCL ( 8 ). On the other hand, Shimizu et al showed that dermal eosinophils and epidermal kallikrein 5 may play a role on itching in MF patients, however, not MCs ( 26 ). Tancre`de-Bohin et al found blood eosinophilia was associated with disease progression and disease- specific death ( 9 ). The prognostic value of blood eosinophilia in various cancers, especially hematological malignancies, have been investigated in pediatric patients ( 27 , 28 ). However, there is no data on the prognostic value of elevated blood eosinophil levelsin pediatric MF patients. In our study, the frequency of patients with elevated blood eosinophil levels was significantly higher in MF patients compared with healthy controls. (p = 0.008) Moreover, there was a significant difference in the frequency of patients with elevated blood eosinophil levels according to MF type (p = 0.013); 66.7%in hyperpigmented MF, 37.5% in folliculotropic MF and 6.7%in hypopigmented MF. In our study, the lowest frequency of patients with elevated blood eosinophil levels in hypopigmented MF patients. Açıklama However, since our patient number was small, the relationship between elevated blood eosinophil levels and MF types can be understood more clearly with studies conducted with a larger number of patients. Furthermore, several studies have reported increased IgE levels in MF patients compared with healthy controls ( 30 , 31 ). Kural et al showed a higher prevalance of allergen-specific IgEs in patients with MF compared with healthy controls and suggested that atopy is common in patients with MF ( 31 ). However, contraversely, Vonderheid et al did not find a significant difference in IgEs specific for aeroallergens in plaque-phase MF compared with the controls ( 32 ). They suggested that there is no increased prevalence of atopy in both typical or atypical expressions of MF. However, they showed that MF patients with a history of atopy had increased IgE levels and higher eosinophils compared with nonatopic MF patients and also a positive correlation between the IgE and eosinophil counts and the disease severity. They explained this situation with the effect of cytokines (IL-4, IL-13, IL-5) produced by Th2-polarized neoplastic T cells that stimulating the production of IgE and eosinophils ( 7 , 32 ). In support of this, Mehrany et al. reported that no difference in the prevalence of atopy between healthy individuals and patients with MF and patients with Sezary syndrome, and furthermore, there was no difference in the prevalence of atopy in Sezary syndrome compared to MF ( 33 ). The prognostic role of NLR and PLR in adult MF, has been investigated ( 34 – 36 ). Di Raimondo et al demonstrated a higher disease progression (24.4%) in patients with higher NLR (median 2.64), than patients with lower NLR (median 1.88) ( 34 ). Similarly, Cengiz et al. showed an association between the advanced disease stage and NLR levels ( 35 ). They suggested that the NLR may be used to estimate the prognosis in MF and may be helpful in making a certain diagnosis in early stages ( 35 ). Solak et al showed higher NLR, PLR, and CRP values in MF patients compared to the healthy controls ( 36 ). Contraversely, we found no significant difference in the NLR and PLR values between pediatric MF patients and healthy controls. The contradictory results in studies on CBC parameters can be explained by the age of the patient population included in the study and whether the disease is in the early or advanced stages. To the best of our knowledge, there is no previous report describing decreased peripheral neutrophil counts in MF patients. In MF, malignant T cells drive a shift from a protective Th1 toward a Th2-dominant immune profile, characterized by elevated IL-4 and IL-13 production. It has been reported that the expression of arginase-1 can be increased by Th2 cytokines, including IL-4, IL-10, and IL-13 ( 16 ). We speculate that increased arginase-1 activity may reduce extracellular L-arginine levels, thereby weakening neutrophil survival signaling and promoting functional exhaustion or premature apoptosis. Such a Th2-mediated metabolic suppression could therefore represent a plausible explanation for the lower neutrophil counts observed in our MF cohort. Elevated LDH level is also known as a predictive factor for disease progression in MF ( 37 ). In our study, LDH levels were significantly higher in MF patients compared to healthy children. However, since all patients in our study were in the early stage, it is clear that further prospective studies are needed regarding the prognostic significance of LDH levels in children with MF. There is no spesific treatment guideline for the treatment of childhood MF, therefore, the therapeutic approach for MF in children is similar to that in adults. Brazzelli et al( 38 ). reported that in their cohort, adolescents treated with NB-UVB tended to experience shorter remission periods and a higher number of relapses compared with younger children and emphasized that switching to PUVA therapy could be beneficial in achieving longer remission durations among relapsing adolescent patients. In our study, however, no relapse was observed among the adolescent patients during follow-up. Nonetheless, PUVA therapy may be considered in the future if relapses occur, although the potential risk of non-melanoma skin cancer should always be taken into consideration. Conclusions In conclusion, elevated blood eosinophil levels, which we found more frequently in children with MF than in healthy individuals in our study, is not clear if it is related with the prognosis or disease severity in pediatric MF patients. In our study, the MF type with the lowest frequency of patients with elevated blood eosinophil levels was hypopigmented. We assume that the elevated blood eosinophil levels in children is also associated with MF as in adult patients. However, the relationship between elevated blood eosinophil levels, which is suggested to be a poor prognosis indicator in adults, and prognosis of childhood MF is unknown, and prospective studies are needed on childhood MF. The limitations of this study are; its retrospective design, lack of immunohistochemistry and T-cell receptor gene rearrangement analysis, the small number of patients and the fact that all cases were limited to stage IA disease. On the other hand, there are several factors that can influence eosinophil levels such asobesity, presence of metabolic syndrome, asthma, and chronic obstructive pulmonary disease were all significantly associated with higher blood eosinophils. Although patients and controls with AD were excluded from the study, most of the other factors mentioned above were not excluded in our cohort, which represents an important limitation. Declarations Author Contributions: Conceptualization, T.Ç. and Y.Y.; methodology, T.Ç; software, H.A.; validation, B.T.A. and H.A.; formal analysis, B.C.Ö.; investigation, T.Ç.; resources, A.T.E.; data curation,T.Ç.; P.T.; writing—original draft preparation, T.Ç.; writing—review and editing, T.Ç.; R.F-H.; visualization, H.A.; supervision, R.F-H., M.T.Ş and A.T.E. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Institutional Review Board Statement: The study protocol was approved by the Manisa Celal Bayar University Ethics Committee (approval date 12/02/2025 and nr 20.478.486 /2878). Informed Consent Statement: Informed consent was obtained from parents’ of all subjects involved in the study. Data Availability Statement: Data results are available upon reasonable request to the corresponding author. Acknowledgments: None Conflicts of Interest: The authors declare no conflicts of interest. 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Brazzelli V, Bernacca C, Segal A, Barruscotti S, Bolcato V, Michelerio A, et al. Photo-photochemotherapy in Juvenile-onset Mycosis Fungoides: A Retrospective Study on 9 Patients. J Pediatr Hematol Oncol. 2019 Jan;41(1):34-37. Tables Table 1. Clinical characteristics of 29 patients with pediatric mycosis fungoides. Characteristics Number (%) Age (year) Range Mean ±SD 2-17 8.79 ±4.72 MF types Hypopigmented MF Folliculotropic MF Hyperpigmented MF 18 (62.06%) 8 (27.5%) 3 (10.34%) Stage 1A 29 (100%) Abbreviations: CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; Hb, hemoglobin NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; RDW, red blood cell distribution width; WBC, white blood cell. Table 2. The demographic and laboratory characteristics of the patients with mycosis fungoides and the healthy controls. Variables Mycosis fungoides (n=29) Control (n = 29) p value Age (mean ± SD) 8,79 ±4,72 8,69 ±5,05 0.189 Male-Female n (%) 11 (37.9%) - 18(62.1%) 17 (58.6%) - 12(41.4%) 0.459 WBC (×10 3 /ml) 7767.30 ±1990.75 7761.37 ±1819.87 0.265 Neutrophils (10 3 /ml) 3.75 ±1.52 3.8 ±1.29 <0.001* Lymphocyte (10 3 /ml) 3.2 ±1.32 3.13 ±1.51 0.001* Monocytes (10 3 /ml) 0.56 ±0.21 0.53 ±0.17 0.044* Basophils (10 3 /ml) 0.04 ±0.024 0.042 ±0.02 0.376 Eosinophils (10 3 /ml) 0.21 ±0.14 0.22 ±0.15 0.008* MCV 81.67 ±7.4 79.5 ±7.3 0.098 Platelet (10 3 /ml) 325.11 ±70.5 429.4 ±543.6 0.658 RDW (%) 13.51 ±0.87 14.04 ±1.46 0.302 Hb (g/dl) 13.2 ±1.27 12.6 ±1.35 0.211 LDH 218.45 ±47.8 210.96 ±48.6 0.001* NLR 1.36 ±0.77 1.49 ±0.69 0.14 PLR 111.9 ±33.94 120.3 ±42.4 0.235 CRP 2.43 ±4.1 3.2 ±5.6 0.085 ESR (mm/h) 9.5 ±9.1 9.6 ±12.8 0.12 Abbreviations: CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; Hb, hemoglobin NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; RDW, red blood cell distribution width; WBC, white blood cell. *p values in bold are statistically significant. Table 3. Clinical and laboratory characteristics according to MF subtypes. Variables Hypopigmented MF Folliculotropic MF Hyperpigmented MF p value Eosinophils** High Normal 1 (6.7%) 14 (93.3%) 3 (37.5%) 5 (62.5%) 2 (66.7%) 1 (33.3%) 0.01* NLR 1.45±0.89 1.01±0.53 1.43±0.44 0.30 PLR 114.2±34.9 108.3±34.4 109.76±36.6 0.92 Treatment durations(months) 11±4.2 10±3.4 11.5±3 0.79 Treatment response Complete response Partial response No response/Relapse 70% 30% 0% 50% 50% 0% 100% 0% 0% 0.67 LDH High Normal 30.8% 69.2% 42% 58% 0% 100% 0.51 Abbreviations: NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; LDH, lactate dehydrogenase; *p values in bold are statistically significant. **Three patients were excluded because their eosinophil values were unavailable. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Feb, 2026 Reviews received at journal 07 Feb, 2026 Reviewers agreed at journal 02 Feb, 2026 Reviewers invited by journal 27 Jan, 2026 Editor assigned by journal 29 Nov, 2025 Submission checks completed at journal 29 Nov, 2025 First submitted to journal 28 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8228742","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":581525099,"identity":"2bc2a100-b922-4d72-b0fd-8dad580ce3ff","order_by":0,"name":"Tubanur Çetinarslan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYPACCQZ+BsYGBh4gk4+ZgFoemBbJBqgWNiK1MDAYHIDy2Ai5yJ6B/eHnyhwLe+MbyW0P3lQctmdj5zF8wFBjE43bFh5jybPbJBK33UhsN5xz5nBiGzOPsQHDsbTcBtxaGCQbt0kkmN1ObJPmbbudwMbMlibB2HAYjxb2xz+BWuyNZ0O02AO1pP/Ar4XBDGQL4wZpiBbGNmbmYwx4tRzgMbMEakmccf9hm+ScM/+BfmE+LJGAxy/sDeyPbzZuq7Pn7zn+TOJNRZo9P//Bxg8famxwamGQf4BNNAGX8lEwCkbBKBgFRAEAPytPu/TKbVwAAAAASUVORK5CYII=","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Tubanur","middleName":"","lastName":"Çetinarslan","suffix":""},{"id":581525100,"identity":"89bee08a-71d1-470c-bb4b-1d071172c46c","order_by":1,"name":"Beyza Türe Avcı","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Beyza","middleName":"Türe","lastName":"Avcı","suffix":""},{"id":581525101,"identity":"157be85e-ef4e-4f4d-98ab-b68bcb77870e","order_by":2,"name":"Hayrünnisa Arslan","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Hayrünnisa","middleName":"","lastName":"Arslan","suffix":""},{"id":581525102,"identity":"7426264d-eee1-4303-8bc8-407b2ab21cc4","order_by":3,"name":"Aylin Türel Ermertcan","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Aylin","middleName":"Türel","lastName":"Ermertcan","suffix":""},{"id":581525103,"identity":"e31b9d02-d574-446c-91a8-898bcf90e53e","order_by":4,"name":"Beyhan Cengiz Özyurt","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Beyhan","middleName":"Cengiz","lastName":"Özyurt","suffix":""},{"id":581525104,"identity":"cf70008f-5fa1-49eb-9064-677e43ae53f5","order_by":5,"name":"Peyker Temiz","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Peyker","middleName":"","lastName":"Temiz","suffix":""},{"id":581525105,"identity":"c5cf39e6-7bc8-42da-ab2a-9675594d2f74","order_by":6,"name":"Mustafa Turhan Şahin","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Mustafa","middleName":"Turhan","lastName":"Şahin","suffix":""},{"id":581525106,"identity":"08abf321-fdfe-4ca9-84a6-149c2d835cba","order_by":7,"name":"Regina Fölster-Holst","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Regina","middleName":"","lastName":"Fölster-Holst","suffix":""}],"badges":[],"createdAt":"2025-11-28 09:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8228742/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8228742/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101485336,"identity":"e944ce99-63ff-4c50-b5f1-ab8046053d10","added_by":"auto","created_at":"2026-01-30 09:00:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":276454,"visible":true,"origin":"","legend":"\u003cp\u003eErythematous skin-coloured papules and plaques with folliculotropic prominent and lack of hair.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8228742/v1/9852d4790ceee1f6ef34df1c.jpg"},{"id":101485335,"identity":"1a131ee9-0495-44db-9d50-b8cd788dbeb6","added_by":"auto","created_at":"2026-01-30 09:00:00","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":507320,"visible":true,"origin":"","legend":"\u003cp\u003eHypopigmented macules on bilateral lower extremities.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8228742/v1/0d8d799490ed87ccdaba8da3.jpg"},{"id":101751966,"identity":"44b4055a-8062-43b5-b60a-d968197c78d7","added_by":"auto","created_at":"2026-02-03 10:24:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1553666,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8228742/v1/ec946978-6f37-46dd-9031-70257c3b9c73.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The clinical and laboratory findings in pediatric mycosis fungoides- Can elevated blood eosinophil levels be related to the type of mycosis fungoides?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMycosis fungoides (MF) is the most common cutaneous T-cell lymphoma (CTCL) in the general population (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is very rare in childhood, accounting for approximately 5% of cases (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). MF lesions are pruritic, and the severity of itching usually increases as the stage of the disease progresses. Various hypotheses have been proposed regarding the cause of pruritus in MF. Guglielmo et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) reported that pruritus in MF is mainly associated with Th2-related cytokines. Interleukin-4 (IL-4), in cooperation with IL-33, induces IL-31 production, which represents a key mediator in the pathogenesis of itch. IL-31 is produced by IL-4\u0026ndash;stimulated CD4⁺ Th2 cells, mast cells, and dendritic cells. An alternative hypothesis is the presence of underlying atopy in MF patients (\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). On the other hand, there are conflicting results regarding the risk of CTCL in patients with atopic dermatitis (AD) (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). MF may mimick AD with laboratory findings such as elevated blood eosinophil levels and high immunoglobulin E (IgE) levels (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). According to Guglielmo et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), this increase in eosinophil counts and IgE levels results from a shift toward a Th2-dominant immune response driven by cytokines such as IL-5 during disease progression. Moreover, previous studies have demonsrated a positive correlation between the eosinophil levels and the advanced stage of MF (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince MF is very rare in pediatric population, studies evaluating laboratory results in children with MF are limited. In this study, we aimed to investigate the clinical, laboratory and histological findings, treatment outcomes in children with MF in a tertiary centre in Turkey. We also compared the lactate dehidrogenase (LDH) levels, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), complete blood count (CBC) and leukocyte profiles in pediatric patients with MF and healthy children.\u003c/p\u003e"},{"header":"Materials and Method","content":"\u003cp\u003e This retrospective study was performed in Dermatology and Venereology Department of Manisa Celal Bayar University in Turkey The study protocol was approved by the Local Ethics Committee of the university (approval date 12/02/2025 and nr 20.478.486 /2878).\u003c/p\u003e \u003cp\u003eDemographic, clinical and laboratory data, and treatment outcomes of pediatric patients with MF and laboratory data of healthy controls were recorded. NLR was obtained by dividing neutrophil count by lymphocyte count and PLR was obtained by dividing platelet count by lymphocyte count. The neutrophil-to-lymphocyte ratio (NLR) was calculated individually for each patient using absolute neutrophil and lymphocyte counts, and mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation was subsequently reported. Laboratory data including hemoglobin, white blood cell (WBC), neutrophils, lymphocytes, monocytes, eosinophils, basophils and platelets' counts, red blood cell distribution width (RDW), mean corpuscular volume (MCV), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and LDH levels were compared between MF patients and healthy controls .\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Group\u003c/h2\u003e \u003cp\u003eMF patients who were under the age of 18, applied to Manisa Celal Bayar University Hospital Dermatology Outpatient Clinic, were included. The diagnosis of MF was confirmed clinically and histopathologically in all patients. Patients with nonspecific immunosuppression (such as liver and renal diseases, diabetes mellitus, malnutrition, malignancy), patients using systemic immunosuppressive agents, patients with acute and/or chronic infections, patients with concomitant chronic inflammatory diseases, including AD were excluded. Five patients were excluded from the study owing to concomitant comorbid conditions.\u003c/p\u003e \u003cp\u003eTreatment outcomes were classified as no clearance (persistent lesions), partial clearance (documented improvement but not complete clearance) and total clearance (complete remission).\u003c/p\u003e \u003cp\u003eAs control group, healthy children applied to Manisa Celal Bayar University Hospital Dermatology Outpatient Clinic under the age of 18 were recruited for this study. All included controls had no previously known cardiovascular, metabolic, inflammatory, or neoplastic diseases and acute and/or chronic infection during laboratory analysis.\u003c/p\u003e \u003cp\u003eDescriptive data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, numbers and percentages. Student's t-test and one-way ANOVA were used to compare continuous data. Student's t-test and Pearson's chisquared test were used to compare categorical variables. A p value of \u0026lt;\u0026thinsp;.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 29 patients (11 females, 37.9%; 18 males, 62.06%), and 29 healthy controls (17 females, 58.6%; 12 males, 41.3%), were included (Table 1). The mean age at diagnosis was 8.79 \u0026plusmn; 4.72 years (range 2-17) in MF patients and 8.69\u0026plusmn;5.05 years (range 1-16) in healthy controls. No significant difference was observed between the MF patients and healthy controls in terms of age and gender (Table 2).\u003c/p\u003e\n\u003cp\u003eNeutrophil count was significantly lower in MF patients (p\u0026thinsp;\u0026lt;\u0026thinsp;.001). LDH levels, eosinophil, lymphocyte and monocyte counts were significantly higher in the MF patients (p=0.001, p=0.008, p\u0026thinsp;=0.001 and p=0.044, respectively) (Table 2).\u003c/p\u003e\n\u003cp\u003eThere was a significant difference in the frequency of patients with elevated blood eosinophil levels according to MF type (p=0.01), elevated blood eosinophil levels was found in 66.7% of hyperpigmented MF, 37.5% of folliculotropic MF (Fig.1), and 6.7% of hypopigmented MF (Fig.2). NLR and PLR were investigated according to MF type, however, no significant difference was found (p=0.303 and p=0.92) (Table 3).\u003c/p\u003e\n\u003cp\u003eAll patients were in stage 1A and treated with NB- UVB. Systemic involvement was investigated using laboratory examinations including CBC, chemistry and LDH, and imaging methods (sonography of lymph nodes and chest X-ray). Phototherapy (NB- UVB) was the most common treatment method (72.4%, 21/29) Among these, 18 patients were between 2 and 14 years of age, and 3 patients were adolescents aged 15 to 18 years,while the remaining patients (27.6%, 8/29) were managed with various topical agents including topical corticosteroids, bexarotene gel, and calcipotriol ointment.\u003c/p\u003e\n\u003cp\u003eMean treatment durations were 11.5\u0026plusmn;3 months in hyperpigmented MF, 11\u0026plusmn;4.2 months in hypopigmented MF, and 10\u0026plusmn;3.4 months in folliculotropic MF (FMF). According to MF types, no significant difference was found (p=0.79). In addition, no significant difference was observed in treatment response according to MF type (p=0.67). Complete cure was observed in all patients with hyperpigmented MF; 70% of patients with hypopigmented MF, and 50% of patients with FMF. No relapses were observed among our patients during follow-up, and those who achieved complete remission are being closely monitored for potential recurrence.\u003c/p\u003e\n\u003cp\u003eNo significant difference was found in LDH count according to MF type (p=0.51). LDH levels were found to be normal in all patients with hyperpigmented MFs and high in 42% of FMFs (n=3) and high in 30.8% of hypopigmented MFs (n=4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMF is the most common form of CTCL in both adults and children (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).Hypopigmented form is reported as the most common type of MF in children (\u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In our study, consistent with the literature, hypopigmented MF was the most common type, followed by folliculotropic MF. Although FMF (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Based on the study by Tomasini et al.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), we reviewed our eight FMF patients to determine whether they could be classified as early or advanced FMF. In that study, early-stage FMF was defined by follicle-centered, cone-shaped hyperkeratotic (spiky) papules without conventional MF plaques or tumors, and by histopathologic features fulfilling the WHO\u0026ndash;EORTC criteria for early FMF. According to these definitions, our all FMF patients exhibited features consistent with early-stage FMF.\u003c/p\u003e \u003cp\u003eMF lesions are pruritic, and the severity of itching usually increases as the stage of the disease progresses. Approximately 86% of our patients experienced mild pruritus, which improved with symptomatic treatments. The absence of treatment-resistant itching may be associated with the fact that our patients were in the early stage of the disease.\u003c/p\u003e \u003cp\u003eEspecially in geriatric individuals and/or patients with adult-onset AD, the distinction of AD from MF becomes important. Various hypotheses have been proposed regarding the cause of pruritus in MF lesions. While early stages of MF lesions exhibit a predominant Th1 inflammatory microenvironment, it changes to a T helper 2 (Th2)-dominated environment in advanced stages (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). T2 inflammation is mediated by various cells including Th2 cells, eosinophils, basophils, mast cells (MCs) and IgE producing B cells (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). MCs release several itch mediators, primarily histamine. Misery et al found no difference in the number of MCs in the skin of MF patients with or without itching and suggested that antihistamines do not appear to be effective in treating MF itch (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). On the other hand, eosinophils are also one of the main cells that play a role in the itch mechanism and release several chemokines including IL-31 that is thought to be involved in itching in MF (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). IL-31 is released from CD4\u0026thinsp;+\u0026thinsp;Th2 cells as well as eosinophils (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In both AD and CTCL, an increased levels of IL-31 in serum and in the skin, have been reported (\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This situation raises the question of whether there is an atopic diathesis in MF patients (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Moreover, a correlation between serum IL-31 levels and the disease stage of CTCL, have been reported (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). However, Malek et al.(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) did not show difference on IL-31 levels between pruritic and non-pruritic patients with CTCL.. Furthermore, Olszewska et al (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), showed significantly higher serum IL-31 levels in both AD and CTCL patients than in healthy controls, however, significantly higher IL-31 serum level was shown in AD than CTCL. Moreover, they reported a positive correlation between the IL-31 serum level and pruritus severity in AD patients, however not in CTCL. They suggested that IL-31 does not play a role in the pruritus in CTCL and it can be attributed to downregulation of IL-31 due to suppression of the benign T-cells by the dense dermal infiltrate of malignant T cells in advanced-stage CTCL (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the other hand, Shimizu et al showed that dermal eosinophils and epidermal kallikrein 5 may play a role on itching in MF patients, however, not MCs (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Tancre`de-Bohin et al found blood eosinophilia was associated with disease progression and disease- specific death (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The prognostic value of blood eosinophilia in various cancers, especially hematological malignancies, have been investigated in pediatric patients (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). However, there is no data on the prognostic value of elevated blood eosinophil levelsin pediatric MF patients. In our study, the frequency of patients with elevated blood eosinophil levels was significantly higher in MF patients compared with healthy controls. (p\u0026thinsp;=\u0026thinsp;0.008) Moreover, there was a significant difference in the frequency of patients with elevated blood eosinophil levels according to MF type (p\u0026thinsp;=\u0026thinsp;0.013); 66.7%in hyperpigmented MF, 37.5% in folliculotropic MF and 6.7%in hypopigmented MF. In our study, the lowest frequency of patients with elevated blood eosinophil levels in hypopigmented MF patients. A\u0026ccedil;ıklama However, since our patient number was small, the relationship between elevated blood eosinophil levels and MF types can be understood more clearly with studies conducted with a larger number of patients.\u003c/p\u003e \u003cp\u003eFurthermore, several studies have reported increased IgE levels in MF patients compared with healthy controls (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Kural et al showed a higher prevalance of allergen-specific IgEs in patients with MF compared with healthy controls and suggested that atopy is common in patients with MF (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). However, contraversely, Vonderheid et al did not find a significant difference in IgEs specific for aeroallergens in plaque-phase MF compared with the controls (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). They suggested that there is no increased prevalence of atopy in both typical or atypical expressions of MF. However, they showed that MF patients with a history of atopy had increased IgE levels and higher eosinophils compared with nonatopic MF patients and also a positive correlation between the IgE and eosinophil counts and the disease severity. They explained this situation with the effect of cytokines (IL-4, IL-13, IL-5) produced by Th2-polarized neoplastic T cells that stimulating the production of IgE and eosinophils (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). In support of this, Mehrany et al. reported that no difference in the prevalence of atopy between healthy individuals and patients with MF and patients with Sezary syndrome, and furthermore, there was no difference in the prevalence of atopy in Sezary syndrome compared to MF (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prognostic role of NLR and PLR in adult MF, has been investigated (\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Di Raimondo et al demonstrated a higher disease progression (24.4%) in patients with higher NLR (median 2.64), than patients with lower NLR (median 1.88) (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Similarly, Cengiz et al. showed an association between the advanced disease stage and NLR levels (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). They suggested that the NLR may be used to estimate the prognosis in MF and may be helpful in making a certain diagnosis in early stages (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Solak et al showed higher NLR, PLR, and CRP values in MF patients compared to the healthy controls (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Contraversely, we found no significant difference in the NLR and PLR values between pediatric MF patients and healthy controls. The contradictory results in studies on CBC parameters can be explained by the age of the patient population included in the study and whether the disease is in the early or advanced stages.\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, there is no previous report describing decreased peripheral neutrophil counts in MF patients. In MF, malignant T cells drive a shift from a protective Th1 toward a Th2-dominant immune profile, characterized by elevated IL-4 and IL-13 production. It has been reported that the expression of arginase-1 can be increased by Th2 cytokines, including IL-4, IL-10, and IL-13 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). We speculate that increased arginase-1 activity may reduce extracellular L-arginine levels, thereby weakening neutrophil survival signaling and promoting functional exhaustion or premature apoptosis. Such a Th2-mediated metabolic suppression could therefore represent a plausible explanation for the lower neutrophil counts observed in our MF cohort.\u003c/p\u003e \u003cp\u003eElevated LDH level is also known as a predictive factor for disease progression in MF (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). In our study, LDH levels were significantly higher in MF patients compared to healthy children. However, since all patients in our study were in the early stage, it is clear that further prospective studies are needed regarding the prognostic significance of LDH levels in children with MF.\u003c/p\u003e \u003cp\u003e There is no spesific treatment guideline for the treatment of childhood MF, therefore, the therapeutic approach for MF in children is similar to that in adults. Brazzelli et al(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). reported that in their cohort, adolescents treated with NB-UVB tended to experience shorter remission periods and a higher number of relapses compared with younger children and emphasized that switching to PUVA therapy could be beneficial in achieving longer remission durations among relapsing adolescent patients. In our study, however, no relapse was observed among the adolescent patients during follow-up. Nonetheless, PUVA therapy may be considered in the future if relapses occur, although the potential risk of non-melanoma skin cancer should always be taken into consideration.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, elevated blood eosinophil levels, which we found more frequently in children with MF than in healthy individuals in our study, is not clear if it is related with the prognosis or disease severity in pediatric MF patients. In our study, the MF type with the lowest frequency of patients with elevated blood eosinophil levels was hypopigmented. We assume that the elevated blood eosinophil levels in children is also associated with MF as in adult patients. However, the relationship between elevated blood eosinophil levels, which is suggested to be a poor prognosis indicator in adults, and prognosis of childhood MF is unknown, and prospective studies are needed on childhood MF.\u003c/p\u003e \u003cp\u003eThe limitations of this study are; its retrospective design, lack of immunohistochemistry and T-cell receptor gene rearrangement analysis, the small number of patients and the fact that all cases were limited to stage IA disease. On the other hand, there are several factors that can influence eosinophil levels such asobesity, presence of metabolic syndrome, asthma, and chronic obstructive pulmonary disease were all significantly associated with higher blood eosinophils. Although patients and controls with AD were excluded from the study, most of the other factors mentioned above were not excluded in our cohort, which represents an important limitation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Conceptualization, T.\u0026Ccedil;. and Y.Y.; methodology, T.\u0026Ccedil;; software, H.A.; validation, B.T.A. and H.A.; formal analysis, B.C.\u0026Ouml;.; investigation, T.\u0026Ccedil;.; resources, A.T.E.; data curation,T.\u0026Ccedil;.; P.T.; writing\u0026mdash;original draft preparation, T.\u0026Ccedil;.; writing\u0026mdash;review and editing, T.\u0026Ccedil;.; R.F-H.; visualization, H.A.; supervision, R.F-H., M.T.Ş and A.T.E. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement:\u003c/strong\u003e The study protocol was approved by the Manisa Celal Bayar University Ethics Committee (approval date 12/02/2025 and nr 20.478.486 /2878).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u003c/strong\u003e Informed consent was obtained from parents\u0026rsquo; of all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e Data results are available upon reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors declare no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCeppi F, Pope, E, Ngan B, Abla O. Primary cutaneous lymphomas in children and adolescents. Pediatr Blood Cancer 2016, 63, 1886\u0026ndash;1894.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAssaf C, Gellrich S, Steinhoff, Nashan D, Weisse F, Dippel E, et al. Cutaneous lymphomas in Germany: an analysis of the Central Cutaneous Lymphoma Registry of the German Society of Dermatology (DDG). J Dtsch Dermatol Ges 2007, 5, 662\u0026ndash;668.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGuglielmo A, Zengarini C, Agostinelli C, Motta G, Sabattini E, Pileri A. The Role of Cytokines in Cutaneous T Cell Lymphoma: A Focus on the State of the Art and Possible Therapeutic Targets. Cells 2024, 13, 584.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWan J, Shin DB, Syed MN, Abuabara K, Lemeshow AR, Fuxench ZCC, et al. Malignancy risk in patients with atopic dermatitis: a population-based cohort study. Br J Dermatol. 2023, 189(1), 53-61.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLegendre L, Barnetche T, Mazereeuw-Hautier J, Meyer, N, Murrell D, Paul C. Risk of lymphoma in patients with atopic dermatitis and the role of topical treatment: a systematic review and meta-analysis. J Am Acad Dermatol. 2015,72(6), 992-1002.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMansfield KE, Schmidt SAJ, Darvalics B, Mulick A, Abuabara K, Wong AYS, et al. Association between atopic eczema and cancer in England and Denmark. JAMA Dermatol. 2020, 156(10), 1086-1097.\u003c/li\u003e\n \u003cli\u003eVonderheid EC, Hamilton RG, Kadin ME. Mycosis Fungoides and Its Relationship to Atopy, Serum Total IgE, and Eosinophil Counts. Clin Lymphoma Myeloma Leuk. 2021, 21(4), 279-288.e7. doi: 10.1016/j.clml.2020.11.007. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOlszewska B, Sokołowska-Wojdyło M, Lakomy J, Nowicki RJ. The ambiguous pruritogenic role of interleukin-31 in cutaneous T-cell lymphomas in comparison to atopic dermatitis: a review. Postepy Dermatol Alergol. 2020, 37(3), 319-325. doi: 10.5114/ada.2020.96260. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTancr\u0026egrave;de-Bohin E, Ionescu MA, de La Salmoni\u0026egrave;re P, Dupuy A, Rivet J, Rybojad M, et al. Prognostic value of blood eosinophilia in primary cutaneous T-cell lymphomas. Arch Dermatol. 2004, 140(9), 1057-61. doi: 10.1001/archderm.140.9.1057.\u003c/li\u003e\n \u003cli\u003eToro JR, Stoll HL, Stomper PC, Oseroff AR. Prognostic factors and evaluation of mycosis fungoides and Se ́zary syndrome. J Am Acad Dermatol. 1997, 37, 58-67.\u003c/li\u003e\n \u003cli\u003eWu JH, Cohen BA, Sweren RJ. Mycosis fungoides in pediatric patients: clinical features, diagnostic challenges, and advances in therapeutic management. Pediatr Dermatol 2020, 37, 18\u0026ndash;28.\u003c/li\u003e\n \u003cli\u003eNanda A, Al-Ajmi H. Mycosis fungoides in children and adolescents. Expert Rev Dermatol. 2013, 8, 309-20.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLaws PM, Shear NH, Pope E. Childhood mycosis fungoides: experience of 28 patients and response to phototherapy. Pediatr Dermatol. 2014, 31, 459-64.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eValencia Ocampo OJ, Julio L, Zapata V, Correa LA, Vasco C, Correa S, et al. Mycosis Fungoides in Children and Adolescents: A Series of 23 Cases. Actas Dermosifiliogr (Engl Ed). 2020, 111(2), 149-156. doi: 10.1016/j.ad.2019.04.004.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKothari R, Szepietowski JC, Bagot M, Sandhu S, Patil A, Grabbe S, et al. Mycosis fungoides in pediatric population: comprehensive review on epidemiology, clinical presentation, and management. Int J Dermatol. 2022, 61(12), 1458-1466. doi: 10.1111/ijd.16098.\u003c/li\u003e\n \u003cli\u003eTomasini C, Michelerio A, Quaglino P. Spiky/keratosis-pilaris-like early follicular mycosis fungoides: A clinicopathologic study of 20 cases with extended follow-up. J Cutan Pathol. 2021 Sep;48(9):1124-1132.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eStolearenco V, Namini MRJ, Hasselager SS, Gluud M, Buus TB, Willerslev-Olsen A, et al. Cellular interactions and inflammation in the pathogenesis of cutaneous T-cell lymphoma. Front Cell Dev Biol. 2020, 8, 851.\u003c/li\u003e\n \u003cli\u003eScanlon ST, McKenzie AN. Type 2 Innate Lymphoid Cells: New Players in Asthma and Allergy. Curr Opin in Immunol. 2012, 24, 6, 707\u0026ndash;712.\u003c/li\u003e\n \u003cli\u003eMisery L. Pruritus in cutaneous T-cell lymphomas. In: Itch: Mechanisms and Treatment. Carstens E, Akiyama T. Boca Raton (FL): CRC Press/Taylor \u0026amp; Francis, 2014: Chapter 8.\u003c/li\u003e\n \u003cli\u003eKunsleben N, R\u0026uuml;drich U, Gehring M, Novak N, Kapp A, Raap U. IL-31 induces chemotaxis, calcium mobilization, release of reactive oxygen species, and CCL26 in eosinophils, which are capable to release IL-31. J Invest Dermatol 2015, 135, 1908-11.\u003c/li\u003e\n \u003cli\u003eCornelissen C, L\u0026uuml;scher-Firzlaff J, Baron JM, L\u0026uuml;scher B. Signaling by IL-31 and functional consequences. Eur J Cell Biol 2012, 91, 552- 66.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDillon SR, Sprecher C, Hammond A, Bilsborough J, Rosenfeld-Franklin M, Presnell SR, et al. Interleukin 31, a cytokine produced by activated T cells, induces dermatitis in mice. Nat Immunol 2004, 5, 752-60. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMalek M, Gleń J, Rębała K, Kowalczyk A, Sobjanek M, Nowicki R, et al. IL-31 does no correlate to pruritus related to early stage cutaneous T-cell lymphomas but is involved in pathogenesis of the disease. Acta Derm Venereol 2015, 95, 283-8.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSinger EM, Shin DB, Nattkemper LA, Benoit BC, Klein RS, Didigu CA, et al. IL-31 is produced by the malignant T-cell population in cutaneous T-cell lymphoma and correlates with CTCL pruritus. J Invest Dermatol 2013, 133, 2783-5.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOhmatsu H, Sugaya M, Suga H, Morimura S, Miyagaki T, Kai H, et al. Serum IL-31 levels are increased in patients with cutaneous T-cell lymphoma. Acta Derm Venereol 2012, 92, 282-3.\u003c/li\u003e\n \u003cli\u003eShimizu K, Andoh T, Makino \u0026nbsp;T, Yoshihisa Y, Mizawa M, Shimizu, T. Mechanisms of itching in mycosis fungoides: grade of itching correlates with eosinophil infiltration and kallikrein 5 expression. Eur J Dermatol 2019, 29 (3), 268\u0026ndash;73. doi: 10.1684/ejd.2019.3560.\u003c/li\u003e\n \u003cli\u003eKlein K, de Haas V, Bank \u0026nbsp;IEM, Beverloo HB, Zwaan CM, Kaspers \u0026nbsp;GL. Clinical and prognostic significance of eosinophilia and inv(16)/t(16;16) in pediatric acute myelomonocytic leukemia (AML-M4). Pediatr Blood Cancer. 2017, 64(10).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCreutzig U, Niederbiermann G, Ritter J, Harbott J, L\u0026ouml;ffler H, Schellong G. Prognostic significance of eosinophilia in acute myelomonocytic leukemia in relation to induction treatment. Haematol Blood Transfus. 1990, 33, 226-32. doi: 10.1007/978-3-642-74643-7_41.\u003c/li\u003e\n \u003cli\u003eHartl S, Breyer MK, Burghuber OC, Ofenheimer A, Schrott A, Urban MH, Agusti A, Studnicka M, Wouters EFM, Breyer-Kohansal R. Blood eosinophil count in the general population: typical values and potential confounders. Eur Respir J. 2020 May 14;55(5):1901874. doi: 10.1183/13993003.01874-2019. PMID: 32060069.\u003c/li\u003e\n \u003cli\u003eTan RS, Butterworth CM, McLaughlin H, Malka S, Samman PD. Mycosis fungoides\u0026mdash;a disease of antigen persistence. Br J Dermatol 1974, 91, 607-16.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKural YB, Su O, Onsun N, Uras AR. Atopy, IgE and eosinophilic cationic protein concentration, specific IgE positivity, eosinophil count in cutaneous T cell lymphoma. Int J Dermatol 2010, 49, 390-5.\u003c/li\u003e\n \u003cli\u003eVonderheid EC, Hamilton RG, Kadin ME. Prevalence of atopy and staphylococcal superantigen-specific immunoglobulin E (IgE) antibodies and total serum IgE in primary cutaneous T- and B-cell lymphoma. J Dermatol 2019, 46, 1170-8. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMehrany K, El-Azhary RA, Bouwhuis SA, Pittelkow MR. Cutaneous T-cell lymphoma and atopy: is there an association? Br J Dermatol. 2003, 149(5), 1013-7. doi: 10.1111/j.1365-2133.2003.05551.x.\u003c/li\u003e\n \u003cli\u003eDi Raimondo C, Lombardo P, Tesei C, Esposito F, Meconi F, Secchi R, et al. Role of Neutrophil-to-Lymphocyte Ratio (NLR) in Patients with Mycosis Fungoides. Diagnostics (Basel). 2023, 5;13(11), 1979. doi: 10.3390/diagnostics13111979.\u003c/li\u003e\n \u003cli\u003eCengiz FP, Emiroglu N, Ozkaya DB, Bahali AG, Su O, Onsun N. Prognostic evaluation of neutrophil/lymphocyte ratio in patients with mycosis fungoides. Ann Clin Lab Sci. 2017, 47(1), 25-28.\u003c/li\u003e\n \u003cli\u003eSolak B, Kara R\u0026Ouml;. Systemic inflammation and its relationship with pruritus in early-stage mycosis fungoides. J Cell Mol Med. 2024, 28(4), e18125. doi: 10.1111/jcmm.18125.\u003c/li\u003e\n \u003cli\u003eScarisbrick JJ, Prince HM, Vermeer MH, Quaglino P, Horwitz S, Porcu P, et al. Cutaneous Lymphoma International Consortium study of outcome in advanced stages of mycosis fungoides and S\u0026eacute;zary syndrome: effect of specific prognostic markers on survival and development of a prognostic model. J Clin Oncol. 2015,33(32), 3766-73. doi: 10.1200/JCO.2015.61.7142.\u003c/li\u003e\n \u003cli\u003eBrazzelli V, Bernacca C, Segal A, Barruscotti S, Bolcato V, Michelerio A, et al. Photo-photochemotherapy in Juvenile-onset Mycosis Fungoides: A Retrospective Study on 9 Patients. J Pediatr Hematol Oncol. 2019 Jan;41(1):34-37.\u003cstrong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eClinical characteristics of 29 patients with pediatric mycosis fungoides.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"548\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (year)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2-17\u003c/p\u003e\n \u003cp\u003e8.79 \u0026plusmn;4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMF types\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHypopigmented MF\u003c/p\u003e\n \u003cp\u003eFolliculotropic MF\u003c/p\u003e\n \u003cp\u003eHyperpigmented MF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (62.06%)\u003c/p\u003e\n \u003cp\u003e8 (27.5%)\u003c/p\u003e\n \u003cp\u003e3 (10.34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; Hb, hemoglobin NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; RDW, red blood cell distribution width; WBC, white blood cell.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eThe demographic and laboratory characteristics of the patients with mycosis fungoides and the healthy controls.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMycosis fungoides (n=29)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl (n = 29)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e8,79 \u0026plusmn;4,72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e8,69 \u0026plusmn;5,05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale-Female n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e11 (37.9%) - 18(62.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e17 (58.6%) - 12(41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWBC (\u0026times;10\u003csup\u003e3\u003c/sup\u003e/ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e7767.30 \u0026plusmn;1990.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e7761.37 \u0026plusmn;1819.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.265\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeutrophils (10\u003csup\u003e3\u003c/sup\u003e/ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e3.75 \u0026plusmn;1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e3.8 \u0026plusmn;1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLymphocyte (10\u003csup\u003e3\u003c/sup\u003e/ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e3.2 \u0026plusmn;1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e3.13 \u0026plusmn;1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonocytes (10\u003csup\u003e3\u003c/sup\u003e/ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e0.56 \u0026plusmn;0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e0.53 \u0026plusmn;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.044*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBasophils (10\u003csup\u003e3\u003c/sup\u003e/ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e0.04 \u0026plusmn;0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e0.042 \u0026plusmn;0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEosinophils (10\u003csup\u003e3\u003c/sup\u003e/ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e0.21 \u0026plusmn;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e0.22 \u0026plusmn;0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e81.67 \u0026plusmn;7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e79.5 \u0026plusmn;7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlatelet (10\u003csup\u003e3\u003c/sup\u003e/ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e325.11 \u0026plusmn;70.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e429.4 \u0026plusmn;543.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.658\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRDW (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e13.51 \u0026plusmn;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e14.04 \u0026plusmn;1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHb (g/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e13.2 \u0026plusmn;1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e12.6 \u0026plusmn;1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLDH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e218.45 \u0026plusmn;47.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e210.96 \u0026plusmn;48.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNLR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e1.36 \u0026plusmn;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e1.49 \u0026plusmn;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePLR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e111.9 \u0026plusmn;33.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e120.3 \u0026plusmn;42.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e2.43 \u0026plusmn;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e3.2 \u0026plusmn;5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eESR (mm/h)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e9.5 \u0026plusmn;9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e9.6 \u0026plusmn;12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; Hb, hemoglobin NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; RDW, red blood cell distribution width; WBC, white blood cell.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e*p values in bold are statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Clinical and laboratory characteristics according to MF subtypes.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypopigmented MF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFolliculotropic MF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHyperpigmented MF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEosinophils**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (6.7%)\u003c/p\u003e\n \u003cp\u003e14 (93.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (37.5%)\u003c/p\u003e\n \u003cp\u003e5 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (66.7%)\u003c/p\u003e\n \u003cp\u003e1 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNLR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.45\u0026plusmn;0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.01\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.43\u0026plusmn;0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePLR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e114.2\u0026plusmn;34.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e108.3\u0026plusmn;34.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e109.76\u0026plusmn;36.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment durations(months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e11\u0026plusmn;4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e10\u0026plusmn;3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e11.5\u0026plusmn;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment response\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eComplete response\u003c/p\u003e\n \u003cp\u003ePartial response\u003c/p\u003e\n \u003cp\u003eNo response/Relapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e70%\u003c/p\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50%\u003cbr\u003e\u0026nbsp;50%\u003c/p\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLDH\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30.8%\u003c/p\u003e\n \u003cp\u003e69.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42%\u003c/p\u003e\n \u003cp\u003e58%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; LDH, lactate dehydrogenase; *p values in bold are statistically significant. **Three patients were excluded because their eosinophil values were unavailable.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"mycosis fungoides, pediatric, atopy, elevated blood eosinophil levels, atypical mycosis fungoides","lastPublishedDoi":"10.21203/rs.3.rs-8228742/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8228742/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma, however; it is rare in children. MF may mimick AD with laboratory findings such as elevated blood eosinophil levels and high immunoglobulin E (IgE) levels. Previous studies have demonsrated a positive correlation between the eosinophil levels and the advanced stage of adult MF. We aim to investigate the clinical presentation, treatment modalities and responses in pediatric MF patients and compare the laboratory parameters of children with MF with the healthy controls.\u003c/p\u003e\n\u003cp\u003eA total of 29 pediatric MF patients and 29 healthy controls, were included. All patients were diagnosed with stage IA. Hypopigmented MF was the most common variant (62.06%), followed by folliculotropic (27.58%). Narrow band-UVB was the most commonly treatment method. LDH was significantly higher in the patient group MF patients (p =0.001). There was a significant difference in frequency of patients with elevated blood eosinophil levels according to MF type (p =0.013), elevated eosinophil levels was found in 66.7% of hyperpigmented MF, 37.5% of folliculotropic MF, and 6.7% of hypopigmented MF.\u003c/p\u003e\n\u003cp\u003eElevated blood eosinophil levels, which we found more frequently in children with MF than in healthy individuals in our study, is not clear if it is related with the prognosis or disease severity in pediatric MF patients. In our study, the MF type with the lowest frequency of patients with elevated blood eosinophil levels was hypopigmented. We assume that the elevated blood eosinophil levels in children is also associated with MF as in adult patients. However, the relationship between elevated blood eosinophil levels, which is suggested to be a poor prognosis indicator in adults, and prognosis of childhood MF is unknown, and prospective studies are needed on childhood MF.\u003c/p\u003e","manuscriptTitle":"The clinical and laboratory findings in pediatric mycosis fungoides- Can elevated blood eosinophil levels be related to the type of mycosis fungoides?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-30 08:59:56","doi":"10.21203/rs.3.rs-8228742/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-16T20:14:21+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-07T19:59:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"102031150012743120953731008227485270462","date":"2026-02-02T07:49:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-28T04:58:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-29T05:41:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-29T05:40:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Dermatological Research","date":"2025-11-28T09:09:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"59f34fc6-0592-469b-9e16-0939c73fcd44","owner":[],"postedDate":"January 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T22:23:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-30 08:59:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8228742","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8228742","identity":"rs-8228742","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}