Case and research letter
Allergic contact dermatitis due to acrylates in acrylic gel nails: a report of 3 cases
Dermatitis alérgica de contacto a acrilatos por uñas artificiales acrílicas: estudio de 3 casos
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Vázquez-Osorio, M. Espasandín-Arias, J. García-Gavín, V. Fernández-Redondo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Vázquez-Osorio" "email" => array:1 [ 0 => "rogivaos@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Espasandín-Arias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "García-Gavín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "V." "apellidos" => "Fernández-Redondo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario, Santiago de Compostela, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario, Vigo, Pontevedra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatitis alérgica de contacto a acrilatos por uñas artificiales acrílicas: estudio de 3 casos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acrylates in artificial nails are a well-known cause of allergic contact dermatitis (ACD).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The recent emergence of photobonded acrylic gel nails has resulted in a growing number of cases of ACD in both manicurists and clients.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> As the number of beauty salons offering these new type of nails in Spain is increasing, we might soon see an increase in the incidence of ACD due to acrylates. We describe the case of 3 women, 2 manicurists and a client, with ACD induced by acrylic gel nails. The clinical presentation was different for each patient. Interestingly, 1 of the manicurists experienced an airborne reaction to nail sanding dust.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The epidemiological data, clinical manifestations, and patch test results are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Patch tests were performed according to the International Contact Dermatitis Research Group criteria using the Spanish baseline series (T.R.U.E. TEST and allergEAZE) and an extended series of acrylates (Chemotechnique Diagnostics AB). Positive reactions were observed for 2-hydroxyethyl methacrylate (2-HEMA) and ethylene glycol dimethacrylate (EGDMA) in all 3 patients and for 2-hydroxyethyl acrylate (2-HEA) and nickel in the client. The manicurists’ symptoms improved in a few weeks after avoiding contact with the nail gel. The dermatitis on the fingertips of the client resolved following removal of the artificial nails, although nail dystrophy persisted for several months.</p><p id="par0020" class="elsevierStylePara elsevierViewall">ACD due to acrylates in artificial nails was first described in 1956 by Canizares,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> who reported a case of eczema due to acrylic materials present in artificial nails on the left hand of a manicurist. Since then, many other cases have been reported. In Spain, Roche et al.,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> in an observational, retrospective study of patients with ACD due to acrylates used in sculptured artificial nails, concluded that acrylate monomers were important sensitizers for contact and occupational dermatitis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Artificial nails can contain many kinds of acrylic monomers,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> but most cases of ACD are induced by 2-HEMA, 2-hydroxypropyl methacrylate (2-HPMA), and EGDMA.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Both manicurists and clients can be affected.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> Patients present a wide variety of symptoms, such as hand eczema (the most common symptom), nail changes, paraesthesia, and airborne dermatitis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Photobonded acrylic gel nails are the latest trend in artificial nails and need weak exposure to UV radiation to polymerize.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In 1990, Fisher<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> presented a case of a woman with paraesthesia and nail dystrophy secondary to sculptured acrylic nails. Acrylic gel nails were recently introduced in Spain, and as they are quite affordable, it is possible that we will see many new cases in the coming years. Most patients usually present with fingertip and/or nailfold dermatitis but other manifestations include facial dermatitis and paraesthesia.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Acrylic gel nails contain similar acrylic compounds to those found in other artificial nails, with 2-HEMA and EGDMA being the most common.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Our 3 patients had all been in contact with gel nails before they developed ACD.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Our 3 case reports illustrate that exposure to acrylates in gel nails can induce a wide variety of clinical manifestations in both manicurists and clients. These manifestations include nail dystrophy and airborne dermatitis caused by nail dust. Moreover, acrylates may be present in other common materials such as dental materials or orthopedic prostheses,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> so previously sensitized patients may experience allergic reactions—and even cross-reactions with other acrylic monomers—after re-exposure.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Individuals with ACD to acrylates in artificial nails can safely use silk wrap nails providing they are not allergic to ethyl cyanoacrylate,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> which is present in all nail glues. Furthermore, in cases of occupational ACD, manicurists who decide to continue working with these nails should wear a mask and 4H gloves, which are safer than others as the penetration time for acrylates is over 4<span class="elsevierStyleHsp" style=""></span>h.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally, it is important to alert both manicurists and wearers of artificial nails about the sensitizing potential of acrylates to facilitate the adoption of preventive measures.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article: Vázquez-Osorio I, Espasandín-Arias M, García-Gavín J, Fernández-Redondo V. Allergic contact dermatitis due to acrylates in acrylic gel nails: a report of 3 cases. Actas Dermosifiliogr 2014;105:430–432.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: 2-HEA, 2-hydroxyehtyl acrylate; 2-HEMA, 2-hydroxyethyl methacrylate; EGDMA, ethylene glycol dimethacrylate; F, female; pet, petrolatum.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Epidemiological data</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical presentation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Positive patch test results</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Age, y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Manicurist or client \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Baseline series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Acrylate series \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Manicurist</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fingertip dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1–2 wk</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nickel sulfate 5% pet</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2-HEA 0.1% pet (++) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nail dystrophy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2-HEMA 2% pet (++) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Periungual hyperkeratosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EGDMA 2% pet (++) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Manicurist</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Airborne dermatitis (cheeks, eyelids, forehead and temple area) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 wk</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2-HEMA 2% pet (++) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fingertip dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EGDMA 2% pet (++) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Client</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fingertip dermatitis</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4–6 wk</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2-HEMA 2% pet (++) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EGDMA 2% pet (++) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab493185.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Time between first contact with gel nails and onset of dermatitis.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Epidemiological data, clinical presentation and patch test results.</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" => "Sensitization to acrylates is a common adverse reaction to 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 19 | 11 | 30 |
| 2024 October | 107 | 49 | 156 |
| 2024 September | 109 | 48 | 157 |
| 2024 August | 163 | 59 | 222 |
| 2024 July | 141 | 42 | 183 |
| 2024 June | 138 | 79 | 217 |
| 2024 May | 136 | 54 | 190 |
| 2024 April | 124 | 31 | 155 |
| 2024 March | 119 | 44 | 163 |
| 2024 February | 166 | 34 | 200 |
| 2024 January | 128 | 46 | 174 |
| 2023 December | 128 | 29 | 157 |
| 2023 November | 122 | 35 | 157 |
| 2023 October | 130 | 39 | 169 |
| 2023 September | 128 | 37 | 165 |
| 2023 August | 100 | 22 | 122 |
| 2023 July | 118 | 45 | 163 |
| 2023 June | 87 | 22 | 109 |
| 2023 May | 122 | 40 | 162 |
| 2023 April | 85 | 27 | 112 |
| 2023 March | 84 | 21 | 105 |
| 2023 February | 76 | 33 | 109 |
| 2023 January | 69 | 40 | 109 |
| 2022 December | 76 | 54 | 130 |
| 2022 November | 73 | 39 | 112 |
| 2022 October | 58 | 32 | 90 |
| 2022 September | 42 | 37 | 79 |
| 2022 August | 32 | 38 | 70 |
| 2022 July | 49 | 40 | 89 |
| 2022 June | 39 | 25 | 64 |
| 2022 May | 58 | 49 | 107 |
| 2022 April | 57 | 31 | 88 |
| 2022 March | 59 | 46 | 105 |
| 2022 February | 34 | 30 | 64 |
| 2022 January | 37 | 37 | 74 |
| 2021 December | 48 | 42 | 90 |
| 2021 November | 36 | 46 | 82 |
| 2021 October | 37 | 47 | 84 |
| 2021 September | 42 | 36 | 78 |
| 2021 August | 39 | 33 | 72 |
| 2021 July | 42 | 32 | 74 |
| 2021 June | 48 | 19 | 67 |
| 2021 May | 35 | 28 | 63 |
| 2021 April | 50 | 22 | 72 |
| 2021 March | 46 | 17 | 63 |
| 2021 February | 57 | 22 | 79 |
| 2021 January | 33 | 16 | 49 |
| 2020 December | 40 | 5 | 45 |
| 2020 November | 14 | 13 | 27 |
| 2020 October | 28 | 8 | 36 |
| 2020 September | 25 | 6 | 31 |
| 2020 August | 19 | 14 | 33 |
| 2020 July | 24 | 13 | 37 |
| 2020 June | 23 | 26 | 49 |
| 2020 May | 22 | 20 | 42 |
| 2020 April | 23 | 14 | 37 |
| 2020 March | 14 | 16 | 30 |
| 2020 February | 8 | 5 | 13 |
| 2020 January | 2 | 0 | 2 |
| 2019 December | 8 | 2 | 10 |
| 2019 November | 2 | 0 | 2 |
| 2019 October | 0 | 3 | 3 |
| 2019 September | 8 | 7 | 15 |
| 2019 August | 4 | 8 | 12 |
| 2019 July | 4 | 19 | 23 |
| 2019 June | 4 | 11 | 15 |
| 2019 May | 4 | 32 | 36 |
| 2019 April | 2 | 48 | 50 |
| 2019 March | 2 | 10 | 12 |
| 2019 February | 2 | 10 | 12 |
| 2019 January | 1 | 7 | 8 |
| 2018 December | 4 | 3 | 7 |
| 2018 November | 3 | 6 | 9 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 6 | 6 | 12 |
| 2018 August | 0 | 12 | 12 |
| 2018 July | 0 | 5 | 5 |
| 2018 June | 0 | 2 | 2 |
| 2018 May | 0 | 7 | 7 |
| 2018 April | 0 | 3 | 3 |
| 2018 February | 42 | 6 | 48 |
| 2018 January | 49 | 15 | 64 |
| 2017 December | 51 | 5 | 56 |
| 2017 November | 41 | 7 | 48 |
| 2017 October | 43 | 12 | 55 |
| 2017 September | 32 | 6 | 38 |
| 2017 August | 55 | 7 | 62 |
| 2017 July | 49 | 14 | 63 |
| 2017 June | 33 | 6 | 39 |
| 2017 May | 34 | 6 | 40 |
| 2017 April | 27 | 11 | 38 |
| 2017 March | 19 | 3 | 22 |
| 2017 February | 24 | 3 | 27 |
| 2017 January | 16 | 8 | 24 |
| 2016 December | 31 | 12 | 43 |
| 2016 November | 37 | 5 | 42 |
| 2016 October | 40 | 12 | 52 |
| 2016 September | 62 | 17 | 79 |
| 2016 August | 36 | 5 | 41 |
| 2016 July | 30 | 11 | 41 |
| 2016 June | 23 | 15 | 38 |
| 2016 May | 10 | 9 | 19 |
| 2016 April | 10 | 2 | 12 |
| 2016 March | 11 | 1 | 12 |
| 2016 February | 10 | 18 | 28 |
| 2016 January | 19 | 2 | 21 |
| 2015 December | 6 | 1 | 7 |
| 2015 November | 11 | 5 | 16 |
| 2015 October | 10 | 1 | 11 |
| 2015 September | 6 | 9 | 15 |
| 2015 August | 10 | 2 | 12 |
| 2015 July | 23 | 1 | 24 |
| 2015 June | 16 | 8 | 24 |
| 2015 May | 30 | 25 | 55 |
| 2015 April | 30 | 15 | 45 |
| 2015 March | 19 | 7 | 26 |
| 2015 February | 6 | 6 | 12 |
| 2015 January | 19 | 4 | 23 |
| 2014 December | 14 | 9 | 23 |
| 2014 November | 11 | 12 | 23 |
| 2014 October | 9 | 13 | 22 |
| 2014 September | 3 | 15 | 18 |
| 2014 August | 4 | 9 | 13 |
| 2014 July | 8 | 6 | 14 |
| 2014 June | 5 | 7 | 12 |
| 2014 May | 17 | 11 | 28 |
Show all
