Case and Research Letter
Psoriatic Cheilitis: A Report of 2 Cases Treated Successfully With Topical Tacrolimus and a Review of the Literature
Queilitis psoriásica: Un reporte de 2 casos tratados con éxito con tacrolimus tópico y revisión de la literatura
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Apalla, E. Sotiriou, A. Trigoni, D. Ioannides" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Z." "apellidos" => "Apalla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:4 [ "nombre" => "E." "apellidos" => "Sotiriou" "email" => array:1 [ 0 => "elenasotiriou@yahoo.gr" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Trigoni" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "D." "apellidos" => "Ioannides" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "State Clinic, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "First Dermatology Department, Aristotle University of Thessaloniki, Greece" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Queilitis psoriásica: Un reporte de 2 casos tratados con éxito con tacrolimus tópico y revisión de la literatura" ] ] "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" => 542 "Ancho" => 1500 "Tamanyo" => 132517 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a) Whitish scales on the vermilion borders of both lips in patient 2 before treatment. (b) Mounds of parakeratosis and hypogranulosis, acanthosis, and dilated, vertically elongated papillary vessels (hematoxylin-eosin, original magnification ×20).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is a chronic inflammatory skin disease that typically affects the extremities, trunk, scalp, and nails. Psoriatic cheilitis as an exclusive presentation is very rare,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and to our knowledge, only 5 cases have been reported to date.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–6</span></a> The absence of cutaneous lesions causes diagnostic difficulties that can result in misdiagnosis and inadequate treatment.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the cases of 2 young adults who presented with psoriasis of the vermilion of the lips as the only disease manifestation. Response to topical tacrolimus 0.1% treatment was good in both cases.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The first case involved a 28-year-old white woman referred to our clinic with a 3-month history of scaly plaques on the vermilion of her lips and a clinical diagnosis of contact cheilitis. Clinical examination revealed an erythematous fissured plaque over the entire upper and lower lip surface, covered by thick white-yellowish scales (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Full body examination did not reveal any evidence of intraoral or cutaneous involvement. Apart from a 10-year history of Hashimoto thyroiditis, the patient's medical history was unremarkable. However, she did mention that her brother had psoriasis. Contact cheilitis was excluded following negative patch tests. Subsequent biopsy and histological examination confirmed the clinical suspicion of psoriasis. The patient received initial treatment with salicylic acid 5% ointment twice daily for 5 days, followed by a 1-month course of topical tacrolimus 0.1% twice daily, resulting in adequate control of disease activity (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The patient is currently on maintenance treatment with twice-weekly application of tacrolimus 0.1% ointment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The second case involved a 20-year-old white man referred to our clinic for further assessment of a 2-year history of recurrent erosive cheilitis, characterized by fissures and white-yellowish scales on the vermilion borders of both lips (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Intraoral and cutaneous lesions were absent. The patient reported exacerbations, particularly during winter. His medical history was unremarkable; there was, however, a positive family history of psoriasis (his mother). After excluding contact cheilitis by patch testing, we performed a lip biopsy. Histopathology showed mounds of parakeratosis and hypogranulosis, acanthosis, and dilated and vertically elongated papillary vessels (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B), leading to a diagnosis of psoriatic cheilitis. The patient was started on salicylic acid 5% twice daily for 3 days, followed by topical tacrolimus 0.1% twice daily for the next month. The treatment resulted in the gradual remission of lesions, but discontinuation led to a flare-up, which was managed with the same regimen. To avoid recurrences the patient was advised to use tacrolimus 0.1% twice weekly, with excellent results.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Perioral psoriasis is an unusual presentation of psoriasis. It is clinically characterized by cracking and scaling of the lips and can have a profound emotional, social, and physical impact on patients’ lives.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4</span></a> In the vast majority of the cases, coexistence of typical psoriatic lesions elsewhere on the body facilitates diagnosis. To the best of our knowledge, exclusive lip involvement is very uncommon, with only 5 cases reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–6</span></a> In 2 of these cases, involvement of the vermilion of the lips preceded cutaneous manifestations by at least 2 months.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> Brenner et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> reported a case of psoriatic cheilitis triggered by protruding teeth as a result of Koebner phenomenon; the condition was resolved by replacing the teeth with a nonirritating prosthesis. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the main epidemiological and clinical characteristics of all the cases reported to date, including ours. Perioral psoriasis as a single site of involvement can pose significant diagnostic difficulties. Due to a lack of specific diagnostic criteria, it has been suggested that a chronic course, with resistance to treatment and frequent recurrences, should raise the suspicion of psoriatic cheilitis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> A positive family history and HLA typing have also been described as important in supporting the a diagnosis of perioral psoriasis.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Therapeutic modalities such as topical steroids and tacrolimus alone or in combination with calcipotriol have produced adequate response in patients with perioral psoriasis.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–6,8</span></a> Tacrolimus, a calcineurin-inhibitor with anti-inflammatory properties, lacks the well-known adverse effects associated with steroids. Yamamoto and Nishioka<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> reported a case in which topical tacrolimus ointment was used to treat psoriasis of the vermilion of the lips, with very promising results. Moreover, this treatment combined with salicylic acid gel has been shown to increase the penetration and absorption of the drug, enhancing therapeutic action.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, we have described 2 new cases of psoriatic cheilitis with exclusive lip involvement treated successfully with topical tacrolimus 0.1% in combination with salicylic acid, indicating their possible therapeutic role in this troublesome localization. We suggest that psoriasis should be considered in cases of refractory long-standing eczema-like cheilitis, even in the absence of a positive family or personal history of psoriasis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "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" => 444 "Ancho" => 1501 "Tamanyo" => 80127 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Thick white-yellowish scales strongly attached to the lips of patient #1 before treatment. (b) Resolution of lesions after treatment with topical tacrolimus.</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" => 542 "Ancho" => 1500 "Tamanyo" => 132517 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a) Whitish scales on the vermilion borders of both lips in patient 2 before treatment. (b) Mounds of parakeratosis and hypogranulosis, acanthosis, and dilated, vertically elongated papillary vessels (hematoxylin-eosin, original magnification ×20).</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: CR, complete response; F, female; M, male.</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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">Skin lesions at presentation \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">Oral lesions \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">Treatment \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">Outcome \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">Exclusive lip involvement \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Tosti et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \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><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Steroid cream \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Rahman et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \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><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Triamcinolone acetonide ointment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sehgal et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \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><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tacrolimus<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>calcipotriol<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>betamethasone dipropionate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Ersoy-Evans et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \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><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fluticasone propionate 0.005% ointment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CR \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" title="table-entry " align="left" valign="top">Baz et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \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><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mometasone furoate 0.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CR \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" title="table-entry " rowspan="2" align="left" valign="top">Current cases</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \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><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tacrolimus<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>salicylic acid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" 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">No \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><td class="td" title="table-entry " align="left" valign="top">Tacrolimus<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>salicylic acid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab913357.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Summary of cases of psoriatic cheilitis reported in the literature.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oral psoriasis: 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 22 | 9 | 31 |
| 2024 Octubre | 192 | 65 | 257 |
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| 2024 Febrero | 232 | 53 | 285 |
| 2024 Enero | 227 | 49 | 276 |
| 2023 Diciembre | 210 | 68 | 278 |
| 2023 Noviembre | 183 | 67 | 250 |
| 2023 Octubre | 204 | 73 | 277 |
| 2023 Septiembre | 176 | 47 | 223 |
| 2023 Agosto | 149 | 31 | 180 |
| 2023 Julio | 162 | 67 | 229 |
| 2023 Junio | 119 | 39 | 158 |
| 2023 Mayo | 145 | 30 | 175 |
| 2023 Abril | 125 | 22 | 147 |
| 2023 Marzo | 107 | 26 | 133 |
| 2023 Febrero | 143 | 30 | 173 |
| 2023 Enero | 110 | 49 | 159 |
| 2022 Diciembre | 127 | 53 | 180 |
| 2022 Noviembre | 126 | 48 | 174 |
| 2022 Octubre | 120 | 38 | 158 |
| 2022 Septiembre | 91 | 51 | 142 |
| 2022 Agosto | 95 | 61 | 156 |
| 2022 Julio | 74 | 46 | 120 |
| 2022 Junio | 72 | 27 | 99 |
| 2022 Mayo | 240 | 58 | 298 |
| 2022 Abril | 150 | 43 | 193 |
| 2022 Marzo | 180 | 74 | 254 |
| 2022 Febrero | 167 | 33 | 200 |
| 2022 Enero | 249 | 62 | 311 |
| 2021 Diciembre | 130 | 48 | 178 |
| 2021 Noviembre | 120 | 51 | 171 |
| 2021 Octubre | 115 | 51 | 166 |
| 2021 Septiembre | 105 | 39 | 144 |
| 2021 Agosto | 128 | 51 | 179 |
| 2021 Julio | 95 | 45 | 140 |
| 2021 Junio | 116 | 40 | 156 |
| 2021 Mayo | 119 | 38 | 157 |
| 2021 Abril | 267 | 55 | 322 |
| 2021 Marzo | 189 | 32 | 221 |
| 2021 Febrero | 150 | 31 | 181 |
| 2021 Enero | 188 | 37 | 225 |
| 2020 Diciembre | 98 | 14 | 112 |
| 2020 Noviembre | 73 | 37 | 110 |
| 2020 Octubre | 64 | 19 | 83 |
| 2020 Septiembre | 79 | 26 | 105 |
| 2020 Agosto | 56 | 36 | 92 |
| 2020 Julio | 51 | 24 | 75 |
| 2020 Junio | 59 | 45 | 104 |
| 2020 Mayo | 35 | 15 | 50 |
| 2020 Abril | 27 | 26 | 53 |
| 2020 Marzo | 34 | 27 | 61 |
| 2020 Febrero | 4 | 4 | 8 |
| 2020 Enero | 0 | 9 | 9 |
| 2019 Diciembre | 4 | 11 | 15 |
| 2019 Noviembre | 0 | 6 | 6 |
| 2019 Octubre | 0 | 4 | 4 |
| 2019 Septiembre | 6 | 2 | 8 |
| 2019 Agosto | 0 | 3 | 3 |
| 2019 Julio | 0 | 2 | 2 |
| 2019 Junio | 0 | 15 | 15 |
| 2019 Mayo | 7 | 66 | 73 |
| 2019 Abril | 1 | 8 | 9 |
| 2019 Marzo | 2 | 6 | 8 |
| 2019 Febrero | 2 | 4 | 6 |
| 2019 Enero | 0 | 1 | 1 |
| 2018 Diciembre | 3 | 1 | 4 |
| 2018 Noviembre | 0 | 3 | 3 |
| 2018 Octubre | 1 | 1 | 2 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Agosto | 0 | 1 | 1 |
| 2018 Julio | 1 | 1 | 2 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 6 | 0 | 6 |
| 2018 Febrero | 21 | 3 | 24 |
| 2018 Enero | 32 | 5 | 37 |
| 2017 Diciembre | 39 | 8 | 47 |
| 2017 Noviembre | 14 | 6 | 20 |
| 2017 Octubre | 26 | 3 | 29 |
| 2017 Septiembre | 14 | 15 | 29 |
| 2017 Agosto | 9 | 9 | 18 |
| 2017 Julio | 13 | 1 | 14 |
| 2017 Junio | 9 | 42 | 51 |
| 2017 Mayo | 9 | 18 | 27 |
| 2017 Abril | 10 | 10 | 20 |
| 2017 Marzo | 8 | 36 | 44 |
| 2017 Febrero | 5 | 11 | 16 |
| 2017 Enero | 4 | 2 | 6 |
| 2016 Diciembre | 11 | 14 | 25 |
| 2016 Noviembre | 9 | 20 | 29 |
| 2016 Octubre | 7 | 19 | 26 |
| 2016 Septiembre | 0 | 3 | 3 |
| 2016 Julio | 5 | 2 | 7 |
| 2016 Junio | 16 | 0 | 16 |
| 2016 Mayo | 13 | 4 | 17 |
| 2016 Abril | 8 | 2 | 10 |
| 2016 Marzo | 1 | 1 | 2 |
| 2016 Febrero | 0 | 2 | 2 |
| 2016 Enero | 0 | 6 | 6 |
| 2015 Noviembre | 0 | 4 | 4 |
| 2015 Octubre | 0 | 20 | 20 |
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