Case and Research Letters
Morphea and Extragenital Lichen Sclerosus et Atrophicus After Influenza Vaccination
Morfea y liquen escleroatrófico extragenital generalizados tras vacuna antigripal
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Ferrándiz-Pulido, M. Lera-Imbuluzqueta, M.J. Plazas-Fernandez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Ferrándiz-Pulido" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Lera-Imbuluzqueta" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Ferrándiz" ] 3 => array:2 [ "nombre" => "M.J." "apellidos" => "Plazas-Fernandez" ] 4 => array:1 [ "colaborador" => "on behalf to EPIQA Study Group" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901730402X?idApp=UINPBA000044" "url" => "/15782190/0000010900000001/v1_201801020547/S157821901730402X/v1_201801020547/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Morphea and Extragenital Lichen Sclerosus et Atrophicus After Influenza Vaccination" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "86" "paginaFinal" => "88" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Requena López, Y. Hidalgo García, S. Gómez Díez, B. Vivanco Allende" "autores" => array:4 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Requena López" "email" => array:1 [ 0 => "sheilarequenalopez@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" => "Y." "apellidos" => "Hidalgo García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Gómez Díez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "B." "apellidos" => "Vivanco Allende" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Morfea y liquen escleroatrófico extragenital generalizados tras vacuna antigripal" ] ] "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" => 650 "Ancho" => 975 "Tamanyo" => 113355 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thin, wrinkled, atrophic skin with a cigarette-paper appearance on the patient's back.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Morphea and lichen sclerosus et atrophicus (LSA) are 2 chronic skin diseases of unknown etiology and pathogenesis. A possible relationship with genetic, autoimmune, and infectious factors has been proposed. Very few cases have been reported after the administration of vaccines.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 67-year-old woman with a past history of breast cancer treated by radical mastectomy and implantation of a silicone prosthesis 15 years earlier, was referred to our department for pruritus and progressive induration of the skin. She had not received radiotherapy after her mastectomy and was taking no drugs of interest. She reported the onset of symptoms 10 days after having received the first dose of 0.5<span class="elsevierStyleHsp" style=""></span>ml of Chiroflu, an influenza vaccine of inactivated surface antigen, administered intramuscularly into her left deltoid muscle. The lesion was initially limited to her left deltoid region, the site of injection of the vaccine. However, generalized lesions gradually developed, respecting only her face and causing difficulty of movement, particularly of her shoulders and knees. Physical examination revealed large, indurated, pearly white plaques in some areas (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and atrophic and wrinkled skin in other areas (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Additional tests, including complete blood count, biochemistry, antinuclear, anti-scl 70, and anticentromere antibodies, and serology for <span class="elsevierStyleItalic">Borrelia burgdorferi</span>, were normal or negative. Skin biopsy showed an atrophic epidermis with follicular occlusion and degeneration of the basal layer, edema of the papillary dermis, collagen with a hyalinized appearance, and a band-like lymphocytic infiltrate. The same sample also showed a thickened reticular dermis with thick and compact collagen bundles and a chronic inflammatory infiltrate (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Based on these clinical and histopathological findings, we made a diagnosis of morphea and generalized extragenital LSA and started treatment with oral psoralen–UV-A (PUVA). Given the poor response after 48 treatment sessions, oral prednisone, 20<span class="elsevierStyleHsp" style=""></span>mg/d, was prescribed in combination with subcutaneous methotrexate, 15<span class="elsevierStyleHsp" style=""></span>mg/wk, leading to a significant important in the induration and in mobility after 3 months of treatment, and it was possible to discontinue treatment after 10 months.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">LSA and morphea are skin diseases of unknown etiology, though in many studies they are considered to be autoimmune diseases. They have been associated with infections, trauma, and, less frequently, with the administration of vaccines. We found 14 cases of vaccine-related morphea<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–6</span></a> and a single case of LSA.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> However, only 2 of these cases were of generalized morphea (the vaccines implicated in these cases were bacillus Calmette-Guérin [BCG]<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and tetanus<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>), and neither occurred concomitantly with LSA.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The vaccine implicated in our patient was the inactivated surface antigen influenza vaccine, Chiroflu. This vaccine is recommended for seasonal influenza prophylaxis in persons over 65 years of age, health staff, pregnant women, individuals with respiratory or cardiac diseases, and immunodeficient patients.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Apart from the known adverse effects of vaccination, temporally or geographically related dermatoses have been reported after the intramuscular injection of vaccines, including granuloma annulare after hepatitis B, BCG, or tetanus vaccines, lichen planus after hepatitis B vaccine, and bullous pemphigoid after hepatitis B, DTP (diphtheria, tetanus, pertussis), or influenza vaccines. A temporal relationship was observed between influenza vaccination and the onset of morphea in our patient and, in addition, the first lesion developed at the site of injection of the vaccine. The role of this vaccine in the pathogenesis of morphea is poorly understood, but, as Torrelo et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> suggest, vaccines may stimulate an immune response targeting not only specific antigens of the vaccine but also other nonspecific antigens. An alternative proposal is that the trauma of the injection may cause endothelial damage and tissue hypoxia that could favor the development of morphea-type sclerosis. Trauma is associated with inflammation and the release of cytokines and growth factors, which contribute to the wound healing process at the site of vaccination and to the appearance of sclerosis or morphea.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The coexistence of morphea and LSA continues to be controversial, as some authors consider LSA to be a variant of morphea, with more superficial involvement, while others consider the diseases to be sufficiently different, both clinically and histopathologically, to be considered distinct diseases.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8–10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A number of treatments have been attempted, including high-potency topical corticosteroids, systemic corticosteroids, methotrexate, and psoralen–UV-A PUVA, all with little efficacy.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We have described this case because of the limited number of reports of generalized morphea after vaccination. This is the first to occur after influenza vaccination.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López SR, García YH, Díez SG, Allende BV. Morfea y liquen escleroatrófico extragenital generalizados tras vacuna antigripal. Actas Dermosifiliogr. 2018;109:86–88.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 621 "Ancho" => 975 "Tamanyo" => 92980 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large, intensely indurated, pearly white areas on the abdomen.</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" => 650 "Ancho" => 975 "Tamanyo" => 113355 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thin, wrinkled, atrophic skin with a cigarette-paper appearance on the patient's back.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1295 "Ancho" => 975 "Tamanyo" => 607127 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathology showing an atrophic epidermis, collagen with a hyalinized appearance, and a band-like lymphocytic infiltrate. The reticular dermis is thickened, and contains thick and compact collagen bundles. Stain for elastic fibers, original magnification<span class="elsevierStyleHsp" style=""></span>×100.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Deep morphea after vaccination in two young children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Torrelo" 1 => "J. Suárez" 2 => "I. Colmenero" 3 => "D. Azorín" 4 => "A. Perera" 5 => "A. Zambrano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1525-1470.2006.00289.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2006" "volumen" => "23" "paginaInicial" => "484" "paginaFinal" => "487" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17014648" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Morphea profunda in a young infant after hepatitis B vaccination" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Benmously Mlika" 1 => "N. Kenani" 2 => "T. Badri" 3 => "H. Hammami" 4 => "J. Hichri" 5 => "S. Haouet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2009.02.047" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2010" "volumen" => "63" "paginaInicial" => "1111" "paginaFinal" => "1112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21093674" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post vaccination localized morphea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I. Bukhari" 1 => "S. Al Breiki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Chin Clin Med" "fecha" => "2009" "volumen" => "4" "paginaInicial" => "599" "paginaFinal" => "600" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Deep morphea in a child after pneumococcal vaccination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.T. Viladomiu Ed Valls" 1 => "B.A. Zabaleta" 2 => "A.J. Moreno" 3 => "N.O. Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0378-6323.132259" "Revista" => array:6 [ "tituloSerie" => "Indian J Dermatol Venereol Leprol" "fecha" => "2014" "volumen" => "80" "paginaInicial" => "259" "paginaFinal" => "260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24823409" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric generalized morphea that developed at a BCG vaccination site" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Matsumoto" 1 => "T. Yamamoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2014.06.012" "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2015" "volumen" => "106" "paginaInicial" => "150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25262364" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postvaccination morphea profunda in a child" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Khaled" 1 => "M. Kharfi" 2 => "A. Zaouek" 3 => "S. Rameh" 4 => "R. Zermani" 5 => "B. Fazaa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1525-1470.2011.01548.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2012" "volumen" => "29" "paginaInicial" => "525" "paginaFinal" => "527" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21854420" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lichen sclerosus et atrophicus in a vaccination site" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.L. Anderton" 1 => "D.C. Abele" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1976" "volumen" => "112" "paginaInicial" => "1787" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1008571" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Morphea and lichen sclerosus et atrophicus. Clinical and histopathologic studies in patients with combined features" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Uitto" 1 => "D.J. Santa Cruz" 2 => "E.A. Bauer" 3 => "A.Z. Eisen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1980" "volumen" => "3" "paginaInicial" => "271" "paginaFinal" => "279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7451694" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coexistence of lichen sclerosus and morphea: a retrospective analysis of 472 patients with localized scleroderma from a German tertiary referral center" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Kreuter" 1 => "J. Wischnewski" 2 => "S. Terras" 3 => "P. Altmeyer" 4 => "M. Stücker" 5 => "T. Gambichler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2012.04.003" "Revista" => array:5 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2012" "volumen" => "67" "paginaInicial" => "1157" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22533994" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Morphea coexisting with lichen sclerosus et atrophicus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Tremaine" 1 => "J.E. Adam" 2 => "M. Orizaga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Dermatol" "fecha" => "1990" "volumen" => "29" "paginaInicial" => "486" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2228375" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000001/v1_201801020547/S1578219017303748/v1_201801020547/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/15782190/0000010900000001/v1_201801020547/S1578219017303748/v1_201801020547/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017303748?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 22 | 9 | 31 |
| 2024 October | 162 | 47 | 209 |
| 2024 September | 183 | 35 | 218 |
| 2024 August | 210 | 52 | 262 |
| 2024 July | 177 | 45 | 222 |
| 2024 June | 163 | 32 | 195 |
| 2024 May | 155 | 54 | 209 |
| 2024 April | 138 | 31 | 169 |
| 2024 March | 201 | 38 | 239 |
| 2024 February | 171 | 35 | 206 |
| 2024 January | 168 | 32 | 200 |
| 2023 December | 168 | 30 | 198 |
| 2023 November | 181 | 51 | 232 |
| 2023 October | 220 | 32 | 252 |
| 2023 September | 160 | 31 | 191 |
| 2023 August | 157 | 23 | 180 |
| 2023 July | 223 | 46 | 269 |
| 2023 June | 134 | 20 | 154 |
| 2023 May | 164 | 31 | 195 |
| 2023 April | 148 | 40 | 188 |
| 2023 March | 160 | 36 | 196 |
| 2023 February | 139 | 36 | 175 |
| 2023 January | 104 | 39 | 143 |
| 2022 December | 143 | 41 | 184 |
| 2022 November | 116 | 46 | 162 |
| 2022 October | 103 | 35 | 138 |
| 2022 September | 66 | 73 | 139 |
| 2022 August | 40 | 43 | 83 |
| 2022 July | 85 | 51 | 136 |
| 2022 June | 89 | 43 | 132 |
| 2022 May | 172 | 57 | 229 |
| 2022 April | 222 | 66 | 288 |
| 2022 March | 222 | 66 | 288 |
| 2022 February | 246 | 47 | 293 |
| 2022 January | 320 | 66 | 386 |
| 2021 December | 202 | 49 | 251 |
| 2021 November | 209 | 54 | 263 |
| 2021 October | 230 | 72 | 302 |
| 2021 September | 197 | 44 | 241 |
| 2021 August | 179 | 71 | 250 |
| 2021 July | 132 | 30 | 162 |
| 2021 June | 144 | 37 | 181 |
| 2021 May | 160 | 56 | 216 |
| 2021 April | 327 | 71 | 398 |
| 2021 March | 229 | 40 | 269 |
| 2021 February | 140 | 27 | 167 |
| 2021 January | 123 | 23 | 146 |
| 2020 December | 139 | 26 | 165 |
| 2020 November | 101 | 28 | 129 |
| 2020 October | 89 | 26 | 115 |
| 2020 September | 76 | 26 | 102 |
| 2020 August | 60 | 25 | 85 |
| 2020 July | 50 | 18 | 68 |
| 2020 June | 58 | 47 | 105 |
| 2020 May | 35 | 30 | 65 |
| 2020 April | 30 | 15 | 45 |
| 2020 March | 38 | 22 | 60 |
| 2020 February | 3 | 0 | 3 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 4 | 0 | 4 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 2 | 0 | 2 |
| 2019 July | 6 | 0 | 6 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 5 | 0 | 5 |
| 2019 April | 2 | 0 | 2 |
| 2019 March | 2 | 0 | 2 |
| 2018 December | 5 | 0 | 5 |
| 2018 November | 2 | 0 | 2 |
| 2018 September | 6 | 0 | 6 |
| 2018 February | 88 | 28 | 116 |
| 2018 January | 206 | 37 | 243 |
| 2017 December | 12 | 21 | 33 |
Show all
