Case and Research Letter
Extensive Bowenoid Papulosis of the Vulva Treated by Carbon Dioxide Laser in a Patient With AIDS
Tratamiento con láser de dióxido de carbono de una papulosis bowenoide vulvar extensa en paciente con sida
M. Llamas-Velasco
, E. Vargas, Y. Delgado, A. García-Diez
Corresponding author
Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, Spain
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Múltiples lesiones parduscas aplanadas en la vulva. B. Herida con tejido de granulación 10 días tras el tratamiento con láser. C. En abril de 2009 nuevas placas blanquecinas con superficie aterciopelada diagnósticas de papulosis bowenoide. D. Resultado posquirúrgico tras el segundo tratamiento con láser de CO<span class="elsevierStyleInf">2</span>. E-G. Posteriores recurrencias, controladas con tratamiento.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Llamas-Velasco, E. Vargas, Y. Delgado, A. García-Diez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Llamas-Velasco" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Vargas" ] 2 => array:2 [ "nombre" => "Y." "apellidos" => "Delgado" ] 3 => array:2 [ "nombre" => "A." 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Llamas-Velasco, E. Vargas, Y. Delgado, A. García-Diez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Llamas-Velasco" "email" => array:1 [ 0 => "mar.llamasvelasco@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Vargas" ] 2 => array:2 [ "nombre" => "Y." "apellidos" => "Delgado" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "García-Diez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento con láser de dióxido de carbono de una papulosis bowenoide vulvar extensa en paciente con sida" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1488 "Ancho" => 1547 "Tamanyo" => 129959 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The red line shows the patient's CD4 count during follow-up. The <span class="elsevierStyleItalic">y</span> axis shows the CD4 count as cell s/μL, and the <span class="elsevierStyleItalic">x</span> axis, the month and year each sample was taken.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Bowenoid papulosis of the genitalia in immunocompromised patients is associated with a high risk of recurrence and transformation to infiltrating squamous cell carcinoma on the one hand, and poor response to treatment on the other.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the case of a 50-year-old female smoker diagnosed with human immunodeficiency virus (HIV) infection in 1989 and invasive cervical cancer in 2000. She also had chronic hepatitis C infection complicated by cirrhosis. She had had histopathologically confirmed bowenoid papulosis since 2004. Treatments had included electrocoagulation, cryotherapy, podophyllin resin, as well as imiquimod, but with poor response and tolerance.</p><p id="par0015" class="elsevierStylePara elsevierViewall">When the patient first visited our hospital in March 2005, she had a brownish plaque with well-defined borders and a verrucous surface covering almost the entire area of the external genitalia and the perianal area (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). A new biopsy confirmed the diagnosis of bowenoid papulosis. In December 2005, we decided to administer continuous-wave carbon dioxide (CO<span class="elsevierStyleInf">2</span>) laser therapy at a power of 7.5 W to treat the affected area and the acetowhite lesions identified; a lateral safety margin of 4 to 5 mm was also treated due to the possible presence of subclinical human papillomavirus (HPV) infection. The procedure was performed with the patient under epidural anesthesia. The treated areas were subsequently cleaned and dressed with an antibiotic ointment, and prophylactic valacyclovir was prescribed at a dose of 500 mg every 8<span class="elsevierStyleHsp" style=""></span>hours until complete reepithelization. Total clinical resolution of the lesions was observed at 1 month. The patient underwent follow-up examinations every 3 to 6 months, in addition to 4 treatment sessions with the same anesthesia, fluence, and postoperative care in October 2006, December 2007, April 2009, and June 2009. Complete clinical resolution was achieved each time (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> B-G). The patient's CD4 count during follow-up is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. The control biopsies showed typical features of bowenoid papulosis, with no signs of infiltrating squamous cell carcinoma. During follow-up, the patient was diagnosed with hepatocellular carcinoma in 2008 and with a high-grade anal neoplasm in 2009. The respective treatments were chemoembolization and surgery followed by consolidation radiation therapy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In all, over a period of 6 years we performed 5 sessions of CO<span class="elsevierStyleInf">2</span> laser therapy, the last of which was in April 2009; no adverse effects were observed in any of the sessions. The patient remained free of lesions in the vulvar area from September 2009 until December 2010, when she died following progression of her hepatocellular carcinoma. The only treatment required during this period was cryotherapy of isolated lesions in the area.</p><p id="par0025" class="elsevierStylePara elsevierViewall">CO<span class="elsevierStyleInf">2</span> laser therapy causes minimal postoperative pain<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and produces better cosmetic results than other methods, especially when used on the external genitals.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It has been used since 1988 to treat large bowenoid papulosis lesions that are difficult to treat with other methods.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The primary complications described to date are vesicovaginal fistulas<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and vulvodynia, especially of the posterior commissure or the vulval vestibule.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> CO<span class="elsevierStyleInf">2</span> laser therapy for bowenoid papulosis lesions achieves complete response, and the rate of recurrence is between 12.5% and 21%.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The cure rate appears to be lower (just 34.5%) in HIV-positive patients, in whom HPV infection persists.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Differences in cure rates are less substantial in condylomas treated with CO<span class="elsevierStyleInf">2</span> laser.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In our case, due to the slight fluctuations in CD4 count during follow-up, it is reasonable to rule out an improvement in symptoms due to immune recovery. A number of approaches have been used to treat bowenoid papulosis in immunocompromised patients, such as electrocoagulation, cryotherapy, 5-fluorouracil, intralesional interferon gamma, imiquimod, podophyllin resin, CO<span class="elsevierStyleInf">2</span> laser, and Nd:YAG laser. However, the effectiveness of these treatments is difficult to assess due to the scarcity of cases in the literature.</p><p id="par0030" class="elsevierStylePara elsevierViewall">As evidenced in the present case, immunocompromised patients are more susceptible to HPV-related neoplasms. We have presented this case because we achieved a good clinical response and high patient satisfaction with the cosmetic outcome after only 5 treatment cycles and with no adverse effects. In light of these results, CO<span class="elsevierStyleInf">2</span> laser therapy may be considered an appropriate treatment for immunocompromised patients with extensive and recurrent lesions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Llamas-Velasco M, Vargas E, Delgado Y, García-Diez A. Tratamiento con láser de dióxido de carbono de una papulosis bowenoide vulvar extensa en paciente con sida. Actas Dermosifiliogr. 2013;104:934–936.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1074 "Ancho" => 1301 "Tamanyo" => 299418 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Multiple brownish flattened lesions on the vulva. B, Wound with granulation tissue 10 days after laser treatment. C, New whitish velvety plaques diagnosed as bowenoid papulosis (April 2009). D, Postoperative result following the second treatment session with carbon dioxide laser. E-G, Subsequent instances of recurrence, controlled with treatment.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1488 "Ancho" => 1547 "Tamanyo" => 129959 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The red line shows the patient's CD4 count during follow-up. The <span class="elsevierStyleItalic">y</span> axis shows the CD4 count as cell s/μL, and the <span class="elsevierStyleItalic">x</span> axis, the month and year each sample was taken.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extensive human papillomavirus-related disease (bowenoid papulosis, Bowen's disease, and squamous cell carcinoma) in a patient with hairy cell leukemia: clinical and immunologic evaluation after an interferon alfa trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Lebbe" 1 => "M. Rybojad" 2 => "S. Ochonisky" 3 => "J.M. Miclea" 4 => "O. Verola" 5 => "F. Cordoliani" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1993" "volumen" => "29" "paginaInicial" => "644" "paginaFinal" => "646" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8408802" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Human papillomavirus-related genital disease in the immunocompromised host: Part I" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.H. Gormley" 1 => "C.L. Kovarik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2010.12.050" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2012" "volumen" => "66" "paginaInicial" => "867.e1" "paginaFinal" => "867.e14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22583720" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carbon dioxide laser vaporization of lymphangioma circumscriptum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.L. Bailin" 1 => "G.R. Kantor" 2 => "R.G. Wheeland" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1986" "volumen" => "14" "paginaInicial" => "257" "paginaFinal" => "262" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3081604" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laser therapy of bowenoid papulosis and Bowen's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Landthaler" 1 => "D. Haina" 2 => "R. Brunner" 3 => "W. Waidelich" 4 => "O. Braun-Falco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Dermatol Surg Oncol" "fecha" => "1986" "volumen" => "12" "paginaInicial" => "1253" "paginaFinal" => "1257" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3782597" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bowenoid papulosis of the penis: successful management with neodymium:YAG laser" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.D. Knoll" 1 => "J.W. Segura" 2 => "R.C. Benson Jr." 3 => "J.R. Goellner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "1988" "volumen" => "139" "paginaInicial" => "1307" "paginaFinal" => "1309" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3373609" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vesicovaginal fistula after laser vaporization of vaginal condyloma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Colombel" 1 => "P. Pedron" 2 => "A. Missirlu" 3 => "C. Abbou" 4 => "D. Chopin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Urol" "fecha" => "1995" "volumen" => "154" "paginaInicial" => "1860" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7563365" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vulvodynia after CO<span class="elsevierStyleInf">2</span> laser treatment of the female genital mucosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Tschanz" 1 => "D. Salomon" 2 => "A. Skaria" 3 => "I. Masouye" 4 => "G.L. Vecchietti" 5 => "M. Harms" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "51686" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2001" "volumen" => "202" "paginaInicial" => "371" "paginaFinal" => "372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11455164" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "CO(2) laser vaporization as primary therapy for human papillomavirus lesions. A prospective observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Savoca" 1 => "L.G. Nardo" 2 => "T.F. Rosano" 3 => "S. D‘Agosta" 4 => "F. Nardo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Obstet Gynecol Scand" "fecha" => "2001" "volumen" => "80" "paginaInicial" => "1121" "paginaFinal" => "1124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11846709" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carbon dioxide (CO2)-laser therapy cures macroscopic lesions, but viral genome is not eradicated in men with therapy-resistant HPV infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Lassus" 1 => "H.P. Happonen" 2 => "K.M. Niemi" 3 => "A. Ranki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Sex Transm Dis" "fecha" => "1994" "volumen" => "21" "paginaInicial" => "297" "paginaFinal" => "302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7871441" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Study of persistence and recurrence rates in 106 patients with condyloma and intraepithelial neoplasia after CO2 laser treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "O. Aynaud" 1 => "M. Buffet" 2 => "P. Roman" 3 => "F. Plantier" 4 => "N. Dupin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1684/ejd.2008.0353" "Revista" => array:6 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2008" "volumen" => "18" "paginaInicial" => "153" "paginaFinal" => "158" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18424374" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000010/v1_201311281142/S1578219013002497/v1_201311281142/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000010/v1_201311281142/S1578219013002497/v1_201311281142/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013002497?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 6 | 21 |
| 2024 October | 132 | 50 | 182 |
| 2024 September | 131 | 27 | 158 |
| 2024 August | 159 | 57 | 216 |
| 2024 July | 130 | 47 | 177 |
| 2024 June | 131 | 54 | 185 |
| 2024 May | 118 | 39 | 157 |
| 2024 April | 136 | 20 | 156 |
| 2024 March | 127 | 43 | 170 |
| 2024 February | 113 | 43 | 156 |
| 2024 January | 90 | 32 | 122 |
| 2023 December | 165 | 16 | 181 |
| 2023 November | 171 | 20 | 191 |
| 2023 October | 178 | 13 | 191 |
| 2023 September | 163 | 47 | 210 |
| 2023 August | 96 | 18 | 114 |
| 2023 July | 111 | 39 | 150 |
| 2023 June | 114 | 25 | 139 |
| 2023 May | 129 | 26 | 155 |
| 2023 April | 65 | 26 | 91 |
| 2023 March | 57 | 33 | 90 |
| 2023 February | 58 | 25 | 83 |
| 2023 January | 48 | 32 | 80 |
| 2022 December | 71 | 41 | 112 |
| 2022 November | 31 | 31 | 62 |
| 2022 October | 37 | 21 | 58 |
| 2022 September | 55 | 40 | 95 |
| 2022 August | 31 | 49 | 80 |
| 2022 July | 84 | 37 | 121 |
| 2022 June | 103 | 44 | 147 |
| 2022 May | 148 | 56 | 204 |
| 2022 April | 89 | 37 | 126 |
| 2022 March | 87 | 50 | 137 |
| 2022 February | 97 | 34 | 131 |
| 2022 January | 107 | 50 | 157 |
| 2021 December | 79 | 40 | 119 |
| 2021 November | 74 | 55 | 129 |
| 2021 October | 75 | 45 | 120 |
| 2021 September | 87 | 50 | 137 |
| 2021 August | 69 | 35 | 104 |
| 2021 July | 65 | 37 | 102 |
| 2021 June | 77 | 47 | 124 |
| 2021 May | 103 | 42 | 145 |
| 2021 April | 370 | 39 | 409 |
| 2021 March | 175 | 30 | 205 |
| 2021 February | 165 | 19 | 184 |
| 2021 January | 74 | 20 | 94 |
| 2020 December | 77 | 16 | 93 |
| 2020 November | 73 | 21 | 94 |
| 2020 October | 73 | 29 | 102 |
| 2020 September | 98 | 12 | 110 |
| 2020 August | 65 | 36 | 101 |
| 2020 July | 67 | 21 | 88 |
| 2020 June | 68 | 36 | 104 |
| 2020 May | 70 | 25 | 95 |
| 2020 April | 52 | 39 | 91 |
| 2020 March | 35 | 35 | 70 |
| 2020 February | 3 | 15 | 18 |
| 2020 January | 4 | 9 | 13 |
| 2019 December | 6 | 5 | 11 |
| 2019 November | 4 | 13 | 17 |
| 2019 October | 0 | 11 | 11 |
| 2019 September | 0 | 11 | 11 |
| 2019 August | 9 | 6 | 15 |
| 2019 July | 4 | 22 | 26 |
| 2019 June | 5 | 35 | 40 |
| 2019 May | 6 | 88 | 94 |
| 2019 April | 2 | 66 | 68 |
| 2019 March | 2 | 26 | 28 |
| 2019 February | 1 | 21 | 22 |
| 2019 January | 4 | 13 | 17 |
| 2018 December | 0 | 11 | 11 |
| 2018 November | 2 | 3 | 5 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 53 | 5 | 58 |
| 2018 August | 0 | 21 | 21 |
| 2018 July | 0 | 23 | 23 |
| 2018 June | 0 | 12 | 12 |
| 2018 May | 0 | 9 | 9 |
| 2018 April | 0 | 13 | 13 |
| 2018 March | 42 | 4 | 46 |
| 2018 February | 216 | 14 | 230 |
| 2018 January | 263 | 16 | 279 |
| 2017 December | 252 | 10 | 262 |
| 2017 November | 266 | 14 | 280 |
| 2017 October | 220 | 7 | 227 |
| 2017 September | 244 | 11 | 255 |
| 2017 August | 255 | 14 | 269 |
| 2017 July | 246 | 17 | 263 |
| 2017 June | 218 | 36 | 254 |
| 2017 May | 90 | 28 | 118 |
| 2017 April | 50 | 13 | 63 |
| 2017 March | 61 | 37 | 98 |
| 2017 February | 148 | 19 | 167 |
| 2017 January | 200 | 24 | 224 |
| 2016 December | 177 | 14 | 191 |
| 2016 November | 250 | 27 | 277 |
| 2016 October | 232 | 26 | 258 |
| 2016 September | 286 | 25 | 311 |
| 2016 August | 238 | 17 | 255 |
| 2016 July | 135 | 5 | 140 |
| 2016 June | 15 | 5 | 20 |
| 2016 May | 7 | 15 | 22 |
| 2016 April | 4 | 15 | 19 |
| 2016 March | 10 | 1 | 11 |
| 2016 February | 10 | 1 | 11 |
| 2016 January | 9 | 17 | 26 |
| 2015 December | 9 | 12 | 21 |
| 2015 November | 13 | 10 | 23 |
| 2015 October | 6 | 19 | 25 |
| 2015 September | 4 | 3 | 7 |
| 2015 August | 6 | 3 | 9 |
| 2015 July | 238 | 9 | 247 |
| 2015 June | 178 | 4 | 182 |
| 2015 May | 215 | 10 | 225 |
| 2015 April | 207 | 4 | 211 |
| 2015 March | 232 | 2 | 234 |
| 2015 February | 191 | 6 | 197 |
| 2015 January | 157 | 9 | 166 |
| 2014 December | 151 | 4 | 155 |
| 2014 November | 121 | 5 | 126 |
| 2014 October | 143 | 10 | 153 |
| 2014 September | 112 | 4 | 116 |
| 2014 August | 79 | 6 | 85 |
| 2014 July | 92 | 7 | 99 |
| 2014 June | 112 | 7 | 119 |
| 2014 May | 84 | 10 | 94 |
| 2014 April | 68 | 4 | 72 |
| 2014 March | 59 | 4 | 63 |
| 2014 February | 52 | 6 | 58 |
| 2014 January | 16 | 4 | 20 |
| 2013 December | 17 | 5 | 22 |
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