Case and Research Letter
Acrodermatitis Enteropathica in a Breast-Fed Infant
Acrodermatitis enteropática en bebé alimentado con lactancia materna
E. Gutiérrez-González
, A. Álvarez-Pérez, M. Loureiro, D. Sánchez-Aguilar, J. Toribio
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Departamento de Dermatología, Complejo Hospitalario Universitario, Facultad de Medicina, Santiago de Compostela, Spain
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Gutiérrez-González, A. Álvarez-Pérez, M. Loureiro, D. Sánchez-Aguilar, J. Toribio" "autores" => array:5 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Gutiérrez-González" "email" => array:1 [ 0 => "egutgon@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Álvarez-Pérez" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Loureiro" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Sánchez-Aguilar" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Toribio" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Departamento de Dermatología, Complejo Hospitalario Universitario, Facultad de Medicina, Santiago de Compostela, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Acrodermatitis enteropática en bebé alimentado con lactancia materna" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2055 "Ancho" => 2737 "Tamanyo" => 442775 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Scaly, erythematous plaques on the face (in a periorificial distribution) (A), on the scalp (B), and in the diaper area (C).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acrodermatitis enteropathica (AE) is a rare autosomal recessively inherited disease caused by alterations in zinc absorption in the digestive tract.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Although it was first described in 1942 by Danbolt and Closs,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> it was not until 1973 that Moynahan and Barnes<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> identified its association with low plasma zinc levels. It is estimated to affect 1 in 500<span class="elsevierStyleHsp" style=""></span>000 children.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Clinically, it is characterized by acral and periorificial dermatitis, alopecia, and diarrhea, although this triad of symptoms only occurs in 20% of cases.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> AE usually appears days or weeks after birth in bottle-fed infants, or shortly after discontinuing breastfeeding in exclusively breastfed infants.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Here we describe the case of a full-term male infant who was diagnosed with AE. The only remarkable finding in his history was neonatal indirect hyperbilirubinemia. The patient, who had been exclusively breastfed since birth, developed cutaneous lesions on the scalp, around the mouth, and in the diaper area at 3 months of age. Additionally, his parents reported that he was more irritable at night. He had received various treatments for the cutaneous lesions, including topical and systemic antibiotics, topical antifungal drugs, and topical corticosteroids, but showed no improvement.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Skin examination revealed scaly, erythematous plaques with well-demarcated edges and psoriasiform morphology, and some honey-colored crusts covering zones of erosion. The plaques were located on the face, predominantly in the perioral, perinasal, and frontal areas (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), as well as on the scalp (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) and on the neck, buttocks, and intergluteal cleft (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Additionally, several isolated plaques with similar characteristics were observed on the thighs and on the dorsal surfaces of fingers and toes.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A serum zinc test showed clearly deficient levels of zinc (9<span class="elsevierStyleHsp" style=""></span>μg/dL; normal range, 70–120<span class="elsevierStyleHsp" style=""></span>μg/dL), supporting the suspected diagnosis of AE. Normal zinc levels in maternal milk ruled out an AE-like eruption. After confirming the diagnosis of AE, zinc sulfite treatment was started at a dosage of 3<span class="elsevierStyleHsp" style=""></span>mg/kg/d; this led to rapid resolution of the cutaneous lesions and an improvement in irritability. Currently, after 2 years of treatment, the child shows normal growth parameters for his age, has had no recurrence of the symptoms, and has normal serum zinc levels.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first symptom is usually acral and periorificial dermatitis and only more advanced cases present the classic triad of alopecia, diarrhea, and skin lesions.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The disease is characterized by low levels of serum zinc, caused by deficient absorption of this metal in the digestive tract.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is now known that this zinc deficiency is due to a defect in the AE gene (<span class="elsevierStyleItalic">SLC39A4)</span> located on the 8q24 chromosome, which encodes Zip4, a zinc transporter in the cells of the small intestine, and primarily in the jejunum.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Clinically, scaly erythematous plaques with psoriasiform morphology, distributed symmetrically in acral and periorificial areas, are frequently observed. Other symptoms include vesiculobullous lesions, alopecia, onychodystrophy, onycholysis, pachyonychia, stomatitis, cheilitis, blepharitis, photophobia, and conjunctivitis. When diagnosis is delayed, patients can develop advanced disease, characterized by increased morbidity and mortality; conditions include growth and mental retardation, irritability, slow wound healing, immunity alterations, hypogonadism, and anemia.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Zinc deficiency can have either a genetic or an acquired origin. The genetic form is classically known as AE and, as mentioned above, is caused by a genetically determined defect in zinc absorption. The acquired forms are clinically similar to classic AE. Three basic causes are known: (a) zinc deficiency in maternal milk,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> also known as lactogenic acrodermatitis; (b) a complete lack of zinc in the parenteral nutrition; and (c) the presence of other malabsorption syndromes, such as Crohn disease and celiac disease, in which absorption is compromised, or metabolic disorders associated with a deficit of other trace elements besides zinc.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Diagnosis is primarily clinical, but it is important to acquire data that support the diagnosis (e.g., low serum zinc levels) and to exclude other causes, such as malnutrition, zinc deficiency in maternal milk, and other metabolic alterations.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> While histopathologic findings are not specific, they can be useful for a preliminary diagnosis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Characteristically, zinc replacement therapy at a dosage of 3<span class="elsevierStyleHsp" style=""></span>mg/kg/d<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> leads to rapid improvement and resolution of signs and symptoms, substantiating the diagnosis. It is advisable to begin treatment as soon as possible, since delaying it can have severe consequences, including death.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">AE usually presents after discontinuation of breastfeeding due to the fact that full-term newborns gain sufficient zinc stores during the last 10 weeks of pregnancy. Furthermore, maternal milk normally contains sufficient zinc for infant development. However, on rare occasions, AE can also occur in full-term infants who have been exclusively breastfed,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> as was the case for our patient. It is important to exclude zinc deficiency in maternal milk in such cases, since this condition requires a much shorter treatment than AE, which must be treated and monitored throughout life.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Gutiérrez-González E, et al. Acrodermatitis enteropática en bebé alimentado con lactancia materna. Actas Dermosifiliogr. 2012;103:170–2.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2055 "Ancho" => 2737 "Tamanyo" => 442775 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Scaly, erythematous plaques on the face (in a periorificial distribution) (A), on the scalp (B), and in the diaper area (C).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acrodermatitis enteropathica and an overview of zinc metabolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Maverakis" 1 => "M.A. Fung" 2 => "P.J. Lynch" 3 => "M. Draznin" 4 => "D.J. Michael" 5 => "B. Ruben" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2006.08.015" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2007" "volumen" => "56" "paginaInicial" => "116" "paginaFinal" => "124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17190629" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acrodermatitis enteropathica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V.N. Sehgal" 1 => "S. Jain" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol" "fecha" => "2000" "volumen" => "18" "paginaInicial" => "745" "paginaFinal" => "748" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11173209" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acrodermatitis enteropathica: case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Perafán-Riveros" 1 => "L.F. Sayago" 2 => "A.C. Fortes" 3 => "J.A. Sanches Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2002" "volumen" => "19" "paginaInicial" => "426" "paginaFinal" => "431" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12383101" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acrodermatitis enteropathica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Danbolt" 1 => "K. Closs" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Derm Venereol" "fecha" => "1942" "volumen" => "23" "paginaInicial" => "127" "paginaFinal" => "169" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Zinc therapy in a synthetic diet for lactose intolerance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.J. Moynahan" 1 => "K.M. Barnes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1973" "volumen" => "1" "paginaInicial" => "676" "paginaFinal" => "677" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2564498" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acrodermatitis enteropathica in a full-term breast-fed infant: case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.M. Couto" 1 => "M.F. Reis" 2 => "J.C. Regazzi" 3 => "C. Lerer" 4 => "A. Soares de Sousa" 5 => "D.R. Azulay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2008.03626.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2008" "volumen" => "47" "paginaInicial" => "1056" "paginaFinal" => "1057" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18986355" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nutritional zinc deficiency mimicking acrodermatitis enteropathica in a fully breast-fed infant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Leverkus" 1 => "S. Kütt" 2 => "E.B. Bröcker" 3 => "J. Frank" 4 => "H. Hamm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2006.01734.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2006" "volumen" => "20" "paginaInicial" => "1380" "paginaFinal" => "1381" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17062090" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acrodermatitis enteropathica: a review of 29 Tunisian cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Kharfi" 1 => "N. El Fékih" 2 => "H. Aounallah-Skhiri" 3 => "S. Schmitt" 4 => "B. Fazaa" 5 => "S. Küry" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2008.03734.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2010" "volumen" => "47" "paginaInicial" => "1038" "paginaFinal" => "1044" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18986351" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acrodermatitis enteropathica—lifelong follow-up and zinc monitoring" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Radja" 1 => "R. Charles-Holmes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2002" "volumen" => "27" "paginaInicial" => "62" "paginaFinal" => "63" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11952674" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000002/v1_201304241253/S1578219012000753/v1_201304241253/en/main.assets" "Apartado" => array:4 [ "identificador" => "6169" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000002/v1_201304241253/S1578219012000753/v1_201304241253/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000753?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 0 | 8 |
| 2024 Octubre | 91 | 37 | 128 |
| 2024 Septiembre | 112 | 29 | 141 |
| 2024 Agosto | 106 | 63 | 169 |
| 2024 Julio | 118 | 47 | 165 |
| 2024 Junio | 134 | 38 | 172 |
| 2024 Mayo | 92 | 38 | 130 |
| 2024 Abril | 108 | 18 | 126 |
| 2024 Marzo | 99 | 30 | 129 |
| 2024 Febrero | 88 | 36 | 124 |
| 2024 Enero | 76 | 46 | 122 |
| 2023 Diciembre | 81 | 38 | 119 |
| 2023 Noviembre | 97 | 38 | 135 |
| 2023 Octubre | 77 | 29 | 106 |
| 2023 Septiembre | 99 | 41 | 140 |
| 2023 Agosto | 101 | 24 | 125 |
| 2023 Julio | 114 | 28 | 142 |
| 2023 Junio | 136 | 20 | 156 |
| 2023 Mayo | 158 | 36 | 194 |
| 2023 Abril | 180 | 18 | 198 |
| 2023 Marzo | 107 | 22 | 129 |
| 2023 Febrero | 157 | 23 | 180 |
| 2023 Enero | 93 | 25 | 118 |
| 2022 Diciembre | 97 | 28 | 125 |
| 2022 Noviembre | 63 | 21 | 84 |
| 2022 Octubre | 62 | 18 | 80 |
| 2022 Septiembre | 40 | 34 | 74 |
| 2022 Agosto | 31 | 35 | 66 |
| 2022 Julio | 47 | 37 | 84 |
| 2022 Junio | 36 | 30 | 66 |
| 2022 Mayo | 122 | 34 | 156 |
| 2022 Abril | 120 | 44 | 164 |
| 2022 Marzo | 125 | 63 | 188 |
| 2022 Febrero | 147 | 37 | 184 |
| 2022 Enero | 102 | 36 | 138 |
| 2021 Diciembre | 68 | 46 | 114 |
| 2021 Noviembre | 100 | 46 | 146 |
| 2021 Octubre | 91 | 52 | 143 |
| 2021 Septiembre | 69 | 41 | 110 |
| 2021 Agosto | 70 | 35 | 105 |
| 2021 Julio | 93 | 34 | 127 |
| 2021 Junio | 76 | 30 | 106 |
| 2021 Mayo | 100 | 44 | 144 |
| 2021 Abril | 148 | 67 | 215 |
| 2021 Marzo | 91 | 27 | 118 |
| 2021 Febrero | 75 | 25 | 100 |
| 2021 Enero | 63 | 19 | 82 |
| 2020 Diciembre | 46 | 19 | 65 |
| 2020 Noviembre | 55 | 21 | 76 |
| 2020 Octubre | 40 | 13 | 53 |
| 2020 Septiembre | 36 | 16 | 52 |
| 2020 Agosto | 30 | 22 | 52 |
| 2020 Julio | 26 | 19 | 45 |
| 2020 Junio | 39 | 26 | 65 |
| 2020 Mayo | 21 | 27 | 48 |
| 2020 Abril | 26 | 24 | 50 |
| 2020 Marzo | 45 | 30 | 75 |
| 2020 Febrero | 6 | 9 | 15 |
| 2020 Enero | 0 | 1 | 1 |
| 2019 Diciembre | 0 | 5 | 5 |
| 2019 Noviembre | 0 | 6 | 6 |
| 2019 Octubre | 0 | 4 | 4 |
| 2019 Septiembre | 0 | 6 | 6 |
| 2019 Agosto | 0 | 6 | 6 |
| 2019 Julio | 0 | 15 | 15 |
| 2019 Junio | 0 | 20 | 20 |
| 2019 Mayo | 1 | 30 | 31 |
| 2019 Abril | 1 | 33 | 34 |
| 2019 Marzo | 0 | 16 | 16 |
| 2019 Febrero | 0 | 19 | 19 |
| 2019 Enero | 0 | 8 | 8 |
| 2018 Diciembre | 0 | 9 | 9 |
| 2018 Noviembre | 0 | 3 | 3 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 2 | 1 | 3 |
| 2018 Agosto | 0 | 6 | 6 |
| 2018 Julio | 0 | 2 | 2 |
| 2018 Mayo | 0 | 6 | 6 |
| 2018 Marzo | 17 | 4 | 21 |
| 2018 Febrero | 127 | 10 | 137 |
| 2018 Enero | 117 | 17 | 134 |
| 2017 Diciembre | 123 | 8 | 131 |
| 2017 Noviembre | 77 | 15 | 92 |
| 2017 Octubre | 81 | 7 | 88 |
| 2017 Septiembre | 77 | 23 | 100 |
| 2017 Agosto | 92 | 17 | 109 |
| 2017 Julio | 83 | 9 | 92 |
| 2017 Junio | 99 | 35 | 134 |
| 2017 Mayo | 76 | 27 | 103 |
| 2017 Abril | 66 | 22 | 88 |
| 2017 Marzo | 62 | 40 | 102 |
| 2017 Febrero | 50 | 22 | 72 |
| 2017 Enero | 72 | 21 | 93 |
| 2016 Diciembre | 145 | 20 | 165 |
| 2016 Noviembre | 222 | 18 | 240 |
| 2016 Octubre | 221 | 27 | 248 |
| 2016 Septiembre | 277 | 19 | 296 |
| 2016 Agosto | 248 | 9 | 257 |
| 2016 Julio | 86 | 21 | 107 |
| 2016 Junio | 13 | 18 | 31 |
| 2016 Mayo | 9 | 21 | 30 |
| 2016 Abril | 7 | 3 | 10 |
| 2016 Marzo | 13 | 1 | 14 |
| 2016 Febrero | 9 | 5 | 14 |
| 2016 Enero | 14 | 3 | 17 |
| 2015 Diciembre | 7 | 1 | 8 |
| 2015 Noviembre | 34 | 11 | 45 |
| 2015 Octubre | 65 | 11 | 76 |
| 2015 Septiembre | 75 | 1 | 76 |
| 2015 Agosto | 18 | 10 | 28 |
| 2015 Julio | 160 | 32 | 192 |
| 2015 Junio | 82 | 29 | 111 |
| 2015 Mayo | 103 | 37 | 140 |
| 2015 Abril | 82 | 18 | 100 |
| 2015 Marzo | 51 | 26 | 77 |
| 2015 Febrero | 32 | 18 | 50 |
| 2015 Enero | 38 | 19 | 57 |
| 2014 Diciembre | 47 | 18 | 65 |
| 2014 Noviembre | 44 | 17 | 61 |
| 2014 Octubre | 49 | 25 | 74 |
| 2014 Septiembre | 51 | 14 | 65 |
| 2014 Agosto | 61 | 20 | 81 |
| 2014 Julio | 61 | 17 | 78 |
| 2014 Junio | 77 | 16 | 93 |
| 2014 Mayo | 59 | 18 | 77 |
| 2014 Abril | 76 | 10 | 86 |
| 2014 Marzo | 76 | 29 | 105 |
| 2014 Febrero | 17 | 13 | 30 |
| 2014 Enero | 22 | 7 | 29 |
| 2013 Diciembre | 24 | 9 | 33 |
| 2013 Noviembre | 20 | 10 | 30 |
| 2013 Octubre | 18 | 8 | 26 |
| 2013 Septiembre | 12 | 12 | 24 |
| 2013 Agosto | 13 | 16 | 29 |
| 2013 Julio | 12 | 20 | 32 |
| 2013 Junio | 10 | 17 | 27 |
| 2013 Mayo | 17 | 17 | 34 |
| 2013 Abril | 13 | 20 | 33 |
| 2013 Marzo | 19 | 14 | 33 |
| 2013 Febrero | 44 | 14 | 58 |
| 2013 Enero | 62 | 15 | 77 |
| 2012 Diciembre | 25 | 13 | 38 |
| 2012 Noviembre | 1 | 1 | 2 |
| 2012 Octubre | 1 | 1 | 2 |
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