Case and Research Letters
Multiple Acral Syringomas
Siringomas acrales múltiples
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Gómez-de Castro, B. Vivanco Allende, B. García-García" "autores" => array:3 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Gómez-de Castro" "email" => array:1 [ 0 => "celiagomez_88@hotmail.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" => "B." "apellidos" => "Vivanco Allende" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "B." "apellidos" => "García-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Central de Asturias, Oviedo, Asturias, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Siringomas acrales múltiples" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1134 "Ancho" => 1517 "Tamanyo" => 189257 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Multiple papules of several millimeters in diameter located on the ventral forearm. B, More detailed image showing the erythematous-brownish coloration and monomorphic appearance of the lesions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 40-year-old woman with no personal or family history of interest was seen for a mildly pruritic rash of progressive onset on both forearms that had appeared 2 years earlier. The lesions were not exacerbated by sun exposure and had not improved following treatment with either antihistamines or topical corticosteroids. Physical examination revealed multiple, slightly raised papules of 1 to 2<span class="elsevierStyleHsp" style=""></span>mm in diameter on the ventral forearms. The papules were monomorphic with an erythematous-brownish coloration (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). The patient had no lesions in any other areas of the integument or mucous membranes. Hematoxylin-eosin staining showed an epithelial proliferation in the middle and upper reticular dermis consisting of ductal structures covered with a cuboidal epithelium. Some of the ductal structures had comma-shaped epithelial prolongations (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Mitosis and cellular atypia were absent. Culture for human papilloma virus was negative. Based on these clinical and histological findings the patient was diagnosed with multiple acral syringomas.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Photoprotection and topical treatment with 0.05% tretinoin twice daily were prescribed. After 4 months of treatment the patient reported flattening of the lesions and a reduction in pruritus, and showed good tolerance to the treatment.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Syringoma is a common benign adnexal tumor derived from the intraepidermal portion of the eccrine excretory (acrosyringeal) duct. The most common presentation is small, yellowish or skin-colored papules on the lower eyelids of middle-aged women. Less frequent locations include the neck, thorax, armpits, and genital region.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In 1987 Friedman and Butler<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> proposed a classification system that distinguishes 4 clinical variants of syringoma: localized (solitary or multiple), familial, Down's syndrome-associated, and generalized (multiple or eruptive) forms. Eruptive syringoma can be associated with Nicolau-Balus syndrome, which is characterized by the presence of eruptive syringomas, milium cysts, and vermiculate atrophoderma.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Histologically, syringoma is characterized by the proliferation of cells arranged in nests, cords, or tubular structures and located in the upper dermis. Depending on the plane of section, syringomas can have a comma- or tadpole-like morphology. The tubular structures exhibit ductal differentiation and an eosinophilic cuticle lining the lumen. Bundles of thick, sclerotic collagen are evident in the surrounding stroma. The histological differential diagnosis should include microcystic adnexal carcinoma, desmoplastic trichoepithelioma, sclerodermiform basal cell carcinoma, and sclerosing adenosis of the sweat glands. Syringoma is distinguished from microcystic adnexal carcinoma by its smaller size, greater symmetry, more superficial location in the dermis, and the absence of prominent horn cysts. While solid strands of basophilic epithelial cells and corneal cysts may be observed in desmoplastic trichoepithelioma, ductal structures are absent. Sclerodermiform basal cell carcinoma lacks ductal structures containing amorphous material. Finally, stellate sclerosis, which is absent in syringoma, is very common in the benign condition known as sclerosing adenosis of the sweat glands.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Acral syringoma is limited to the distal areas of the upper and/or lower extremities. This form is very rare, and only a few cases are described in the literature (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6,7</span></a> Distinctive characteristics of this form include onset at more advanced ages and a similar prevalence in men and women.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6,8</span></a> Concomitant periorbital involvement is absent in most reported cases. It is important to highlight the occasional association of acral syringoma with malignant tumors, including pulmonary carcinoid tumor, cutaneous melanoma, basal cell carcinoma, breast carcinoma, and promyelocytic leukemia.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6–8</span></a> Our patient was a healthy woman with no symptoms and no known tumors.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The differential diagnosis of papular acral lesions should include syringoma, as well as lichen planus, milium cysts, urticaria pigmentosa, flat warts, and certain photodermatoses.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Given the benign nature of the process treatment is not required, although aesthetic or symptomatic treatment is often instituted. Available therapeutic options include surgical excision, electrocoagulation, cryotherapy, laser ablation, topical retinoids, and trichloroacetic acid.</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: Gómez-de Castro C, Vivanco Allende B, García-García B. Siringomas acrales múltiples. Actas Dermosifiliogr. 2018;109:834–836.</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" => 1134 "Ancho" => 1517 "Tamanyo" => 189257 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Multiple papules of several millimeters in diameter located on the ventral forearm. B, More detailed image showing the erythematous-brownish coloration and monomorphic appearance of the lesions.</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" => 1130 "Ancho" => 1500 "Tamanyo" => 518554 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Biopsy reveals the presence in the dermis of ductal structures covered with a cuboid epithelium with comma-shaped prolongations (hematoxylin-eosin, original magnification ×200).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Adapted from Valdivielso-Ramos et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></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"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author(s), Y \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age, Y \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Associated Tumors \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hughes and Apisarnthanarax,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> 1977 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dorsal aspect of the fingers of both hands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Asai, 1982 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Periocular area and dorsal aspect of the fingers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">van den Broek, 1982 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Periocular area, forearms, and dorsal aspect of the wrists \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clear cell acanthoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Berbis, 1989 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Flexures of the forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pulmonary carcinoid tumor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Metze, 1990 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dorsal aspect of the hands and forearms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Basal cell carcinomas and melanoma (Breslow thickness, 0.8<span class="elsevierStyleHsp" style=""></span>mm) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">García, 1997 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dorsal aspect of the hands and feet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stage IV breast cancer \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patrizi, 1998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Wrist and forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patrizi, 1998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Breast surgery scar and dorsal aspect of the forearms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tubular breast adenoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Iglesias-Sancho et al, 1999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Flexor surface of the forearm and intermammary cleft \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Martín-García, 2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forearms and distal portions of the arms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Muniesa, 2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dorsal aspect of the phalanges of both hands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Koh, 2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dorsal aspect of the fingers of both hands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balci, 2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forearms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Facial trichoepitheliomas \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valdivielso-Ramos, 2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forearms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Varas-Meis and Prada, 2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forearms and periorbital area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Promyelocytic leukemia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gómez et al, 2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forearms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1886538.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Published Cases of Acral Syringoma.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acral syringoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 7 | 15 |
| 2024 October | 69 | 37 | 106 |
| 2024 September | 81 | 25 | 106 |
| 2024 August | 95 | 54 | 149 |
| 2024 July | 94 | 29 | 123 |
| 2024 June | 70 | 35 | 105 |
| 2024 May | 68 | 36 | 104 |
| 2024 April | 81 | 25 | 106 |
| 2024 March | 71 | 31 | 102 |
| 2024 February | 65 | 29 | 94 |
| 2024 January | 60 | 38 | 98 |
| 2023 December | 53 | 13 | 66 |
| 2023 November | 100 | 25 | 125 |
| 2023 October | 83 | 16 | 99 |
| 2023 September | 68 | 25 | 93 |
| 2023 August | 44 | 14 | 58 |
| 2023 July | 56 | 40 | 96 |
| 2023 June | 66 | 22 | 88 |
| 2023 May | 54 | 25 | 79 |
| 2023 April | 54 | 20 | 74 |
| 2023 March | 55 | 31 | 86 |
| 2023 February | 51 | 24 | 75 |
| 2023 January | 37 | 37 | 74 |
| 2022 December | 52 | 35 | 87 |
| 2022 November | 45 | 33 | 78 |
| 2022 October | 37 | 17 | 54 |
| 2022 September | 25 | 43 | 68 |
| 2022 August | 42 | 42 | 84 |
| 2022 July | 33 | 45 | 78 |
| 2022 June | 35 | 23 | 58 |
| 2022 May | 38 | 44 | 82 |
| 2022 April | 44 | 35 | 79 |
| 2022 March | 35 | 51 | 86 |
| 2022 February | 32 | 29 | 61 |
| 2022 January | 53 | 43 | 96 |
| 2021 December | 33 | 38 | 71 |
| 2021 November | 54 | 40 | 94 |
| 2021 October | 48 | 61 | 109 |
| 2021 September | 43 | 42 | 85 |
| 2021 August | 46 | 40 | 86 |
| 2021 July | 29 | 30 | 59 |
| 2021 June | 33 | 37 | 70 |
| 2021 May | 37 | 56 | 93 |
| 2021 April | 69 | 90 | 159 |
| 2021 March | 69 | 41 | 110 |
| 2021 February | 77 | 49 | 126 |
| 2021 January | 39 | 42 | 81 |
| 2020 December | 34 | 31 | 65 |
| 2020 November | 35 | 43 | 78 |
| 2020 October | 26 | 21 | 47 |
| 2020 September | 33 | 20 | 53 |
| 2020 August | 37 | 28 | 65 |
| 2020 July | 19 | 25 | 44 |
| 2020 June | 31 | 33 | 64 |
| 2020 May | 22 | 16 | 38 |
| 2020 April | 15 | 14 | 29 |
| 2020 March | 15 | 10 | 25 |
| 2020 February | 2 | 0 | 2 |
| 2019 May | 0 | 1 | 1 |
| 2018 October | 5 | 0 | 5 |
Show all
