Case and research letter
Acquired Total Leukonychia in a Patient With Human Immunodeficiency Virus Infection
Leuconiquia total adquirida en paciente infectado por el virus de la inmunodeficiencia humana
Ú. Pielasinski-Rodríguez
, S. Machan, M.C. Fariña-Sabaris, L. Requena-Caballero
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Departamento de Dermatología y Venereología, Fundación Jiménez Díaz, Madrid, Spain
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Pielasinski-Rodríguez, S. Machan, M.C. Fariña-Sabaris, L. Requena-Caballero" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Ú." "apellidos" => "Pielasinski-Rodríguez" "email" => array:1 [ 0 => "suli1702@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Machan" ] 2 => array:2 [ "nombre" => "M.C." "apellidos" => "Fariña-Sabaris" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Requena-Caballero" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Departamento de Dermatología y Venereología, Fundación Jiménez Díaz, Madrid, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Leuconiquia total adquirida en paciente infectado por el virus de la inmunodeficiencia humana" ] ] "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" => 1188 "Ancho" => 1585 "Tamanyo" => 161575 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Detail showing true leukonychia at closer range.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Leukonychia, also known as white nails, is a form of nail discoloration that has been known since antiquity. Baran et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> classified this rare entity in three main types: true leukonychia, when the alteration of the nail plate is caused by changes in the nail matrix; apparent leukonychia, caused by a disturbance of the nail bed; and pseudoleukonychia, in which the alteration of the nail plate is caused by an external factor such as onychomycosis. The condition is classified as totalis, partialis, striata, or punctata depending on the how the nail plate is affected.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 58-year-old man with human immunodeficiency virus (HIV) infection since 1992 but with no other relevant past history. Since starting antiretroviral therapy in 1993, the patient had followed several different treatment regimens using various drugs—zidovudine, didanosine, stavudine, lamivudine, and others—alternating with periods during which his medication was temporarily suspended. The patient remained clinically and immunologically stable and tolerated the drugs well until November 2009, at which time his viral load rose to a detectable level; ongoing treatment with nevirapine was maintained and lamivudine and abacavir were added to the regimen. At the time of writing, the patient continued on this treatment regimen.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was referred to our dermatology unit for assessment of whitening of the nails affecting the whole nail plate of all 10 fingers (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient stated that the leukonychia had first appeared when he started taking lamivudine and abacavir in November 2009. Having ruled out all known causes of true leukonychia and pseudoleukonychia, we diagnosed the patient with idiopathic acquired true leukonychia totalis that did not affect the toenails (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Leukonychia is defined as a whitening of the nails. It was first described in 1919 by Mees,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> who found an association between this alteration of a skin appendage and arsenic poisoning. When nail plate involvement begins at the nail matrix, the condition is considered to be true leukonychia, which can be hereditary or acquired. Hereditary true leukonychia may occasionally be seen in the context of rare, complex syndromes such as LEOPARD syndrome, Bauer syndrome, and keratoderma hypotrichosis leukonychia syndrome.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Acquired true leukonychia can be idiopathic or secondary to injury to the nail matrix, exposure to chemotherapeutic agents or other drugs, or underlying systemic diseases<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> (measles, acute myocardial infarction, pellagra, or Hodgkin lymphoma). Pseudoleukonychia has been seen in cases of liver cirrhosis (Terry nails), hypoalbuminemia (Muehrcke lines), zinc deficiency, renal failure (half-and-half nails), and Kawasaki disease. The pathophysiologic mechanism of true leukonychia is not fully understood, although it is believed to be secondary to abnormal keratinization of the nail plate. The term pseudoleukonychia refers to an alteration of the nail plate caused by the action of an external agent.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Although the literature contains numerous reports of mucocutaneous alterations associated with or specific to patients with HIV infection,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> very few nail disorders have been described in this context<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a>; onychomycosis and tinea pedis are among the most common and can affect up to 1 in 3 HIV-positive patients.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> The next most common nail disorder in these patients is longitudinal melanonychia, which may or may not be associated with zidovudine treatment.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Proximal or subtotal apparent leukonychia has been reported in more than 10% of HIV-positive patients, but acquired true leukonychia not attributable to a specific etiology is extremely rare.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The existence of a direct causal relationship between antiretroviral therapy and the appearance of leukonychia is the subject of debate. According to the literature, the main antiretroviral drug involved in pigmentary changes in the skin and its appendages in HIV-positive patients is zidovudine.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> This drug can induce hyperpigmentation of the mucosas, skin, and nails, ranging from light blue to a dark grayish or brown color.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> None of the other drugs taken by our patient have been associated with the appearance of leukonychia.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Lamivudine has been implicated in alopecia and paronychia; abacavir has been associated with hypersensitivity reactions, rhabdomyolysis, and toxic epidermal necrolysis; and nevirapine has been known to induce a characteristic maculopapular exanthem that appears 4 to 6 weeks after starting treatment.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We have described a case of acquired true leukonychia totalis in a patient with HIV infection. Our review of the literature has revealed no previous reports of cases in which the entire nail plate is affected, as occurred in our patient. In the present case, we ruled out all known causes of true leukonychia and pseudoleukonychia. While it is possible that this alteration of the patient's nails is idiopathic, we must consider the possibility that it is associated with his HIV infection and antiretroviral therapy, given the growing number of new antiretroviral drugs with potential side effects not yet described.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Pielasinski-Rodríguez U, et al. Leuconiquia total adquirida en paciente infectado por el virus de la inmunodeficiencia humana. Actas Dermosifiliogr. 2012;103:934–5.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1172 "Ancho" => 1585 "Tamanyo" => 188860 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Complete whitening of all 10 nail plates on the hands.</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" => 1188 "Ancho" => 1585 "Tamanyo" => 161575 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Detail showing true leukonychia at closer range.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leukonychia. Review and classification" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Grossman" 1 => "R. Scher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "1990" "volumen" => "29" "paginaInicial" => "535" "paginaFinal" => "541" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2242939" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Een verschijnsel bij polyneuritis arsenicosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.A. Mees" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Nederl T Geneesk" "fecha" => "1919" "volumen" => "1" "paginaInicial" => "391" "paginaFinal" => "396" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transverse leukonychia with systemic infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Mautner" 1 => "I. Lu" 2 => "R. Ort" 3 => "M. Grossman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cutis" "fecha" => "2000" "volumen" => "65" "paginaInicial" => "318" "paginaFinal" => "321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10826095" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suspicion of systemic diseases through nail abnormalities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Silva" 1 => "C. Vera" 2 => "M. Kolbach" 3 => "F. Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "/S0034-98872006000200015" "Revista" => array:6 [ "tituloSerie" => "Rev Med Chile" "fecha" => "2006" "volumen" => "134" "paginaInicial" => "231" "paginaFinal" => "238" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16554933" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired leukonychia totalis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Antonarakis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMicm050758" "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2006" "volumen" => "355" "paginaInicial" => "e2" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16837673" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reacciones cutáneas adversas a fármacos en los pacientes con infección por el VIH en la era TARGA" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Blanes" 1 => "I. Belinchón" 2 => "J. Portilla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Act Dermatol" "fecha" => "2009" "volumen" => "100" "paginaInicial" => "253" "paginaFinal" => "265" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transverse leukonychia and AIDS" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V.O. De Carvalho" 1 => "C.R. da Cruz" 2 => "L.P. Marioni" 3 => "J.H. Lima" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Arc Dis Child" "fecha" => "2006" "volumen" => "91" "paginaInicial" => "326" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disorders of the nails and hair associated with human immnunodeficiency virus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.S. Prose" 1 => "K.G. Abson" 2 => "R.K. Scjer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "1992" "volumen" => "31" "paginaInicial" => "453" "paginaFinal" => "457" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1500232" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nail changes in patients infected with human immunodeficiency virus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Cribier" 1 => "M. Leiva Mena" 2 => "D. Rey" 3 => "M. Partisani" 4 => "V. Fabien" 5 => "J.-M. Lang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1998" "volumen" => "134" "paginaInicial" => "1216" "paginaFinal" => "1220" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9801676" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The spectrum of nail disease in patients with human immunodeficiency virus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Ralph" 1 => "A. Lawrence" 2 => "R. Scher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1992" "volumen" => "27" "paginaInicial" => "93" "paginaFinal" => "97" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1619083" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000010/v1_201304241352/S1578219012003186/v1_201304241352/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/15782190/0000010300000010/v1_201304241352/S1578219012003186/v1_201304241352/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012003186?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 16 | 14 | 30 |
| 2024 Octubre | 103 | 43 | 146 |
| 2024 Septiembre | 109 | 36 | 145 |
| 2024 Agosto | 152 | 64 | 216 |
| 2024 Julio | 139 | 36 | 175 |
| 2024 Junio | 147 | 38 | 185 |
| 2024 Mayo | 133 | 39 | 172 |
| 2024 Abril | 117 | 50 | 167 |
| 2024 Marzo | 149 | 47 | 196 |
| 2024 Febrero | 137 | 38 | 175 |
| 2024 Enero | 114 | 42 | 156 |
| 2023 Diciembre | 128 | 26 | 154 |
| 2023 Noviembre | 140 | 45 | 185 |
| 2023 Octubre | 127 | 28 | 155 |
| 2023 Septiembre | 155 | 44 | 199 |
| 2023 Agosto | 127 | 31 | 158 |
| 2023 Julio | 173 | 55 | 228 |
| 2023 Junio | 168 | 37 | 205 |
| 2023 Mayo | 256 | 32 | 288 |
| 2023 Abril | 246 | 38 | 284 |
| 2023 Marzo | 220 | 34 | 254 |
| 2023 Febrero | 194 | 31 | 225 |
| 2023 Enero | 196 | 26 | 222 |
| 2022 Diciembre | 171 | 42 | 213 |
| 2022 Noviembre | 90 | 27 | 117 |
| 2022 Octubre | 96 | 32 | 128 |
| 2022 Septiembre | 114 | 30 | 144 |
| 2022 Agosto | 85 | 38 | 123 |
| 2022 Julio | 89 | 24 | 113 |
| 2022 Junio | 124 | 31 | 155 |
| 2022 Mayo | 190 | 47 | 237 |
| 2022 Abril | 212 | 33 | 245 |
| 2022 Marzo | 201 | 71 | 272 |
| 2022 Febrero | 199 | 50 | 249 |
| 2022 Enero | 221 | 46 | 267 |
| 2021 Diciembre | 173 | 50 | 223 |
| 2021 Noviembre | 181 | 51 | 232 |
| 2021 Octubre | 199 | 61 | 260 |
| 2021 Septiembre | 157 | 54 | 211 |
| 2021 Agosto | 151 | 46 | 197 |
| 2021 Julio | 138 | 31 | 169 |
| 2021 Junio | 145 | 48 | 193 |
| 2021 Mayo | 140 | 52 | 192 |
| 2021 Abril | 325 | 95 | 420 |
| 2021 Marzo | 183 | 36 | 219 |
| 2021 Febrero | 129 | 21 | 150 |
| 2021 Enero | 139 | 41 | 180 |
| 2020 Diciembre | 113 | 32 | 145 |
| 2020 Noviembre | 89 | 25 | 114 |
| 2020 Octubre | 62 | 37 | 99 |
| 2020 Septiembre | 94 | 39 | 133 |
| 2020 Agosto | 64 | 39 | 103 |
| 2020 Julio | 68 | 21 | 89 |
| 2020 Junio | 79 | 39 | 118 |
| 2020 Mayo | 113 | 34 | 147 |
| 2020 Abril | 112 | 29 | 141 |
| 2020 Marzo | 107 | 34 | 141 |
| 2020 Febrero | 15 | 8 | 23 |
| 2020 Enero | 2 | 7 | 9 |
| 2019 Diciembre | 4 | 5 | 9 |
| 2019 Noviembre | 2 | 5 | 7 |
| 2019 Octubre | 0 | 5 | 5 |
| 2019 Septiembre | 4 | 5 | 9 |
| 2019 Agosto | 4 | 4 | 8 |
| 2019 Julio | 4 | 17 | 21 |
| 2019 Junio | 4 | 40 | 44 |
| 2019 Mayo | 4 | 57 | 61 |
| 2019 Abril | 2 | 42 | 44 |
| 2019 Marzo | 0 | 17 | 17 |
| 2019 Febrero | 2 | 3 | 5 |
| 2019 Enero | 0 | 5 | 5 |
| 2018 Diciembre | 5 | 5 | 10 |
| 2018 Noviembre | 1 | 3 | 4 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 6 | 3 | 9 |
| 2018 Agosto | 0 | 4 | 4 |
| 2018 Julio | 0 | 4 | 4 |
| 2018 Junio | 0 | 5 | 5 |
| 2018 Mayo | 0 | 8 | 8 |
| 2018 Abril | 0 | 2 | 2 |
| 2018 Marzo | 5 | 10 | 15 |
| 2018 Febrero | 139 | 7 | 146 |
| 2018 Enero | 107 | 14 | 121 |
| 2017 Diciembre | 167 | 13 | 180 |
| 2017 Noviembre | 83 | 20 | 103 |
| 2017 Octubre | 72 | 7 | 79 |
| 2017 Septiembre | 86 | 14 | 100 |
| 2017 Agosto | 101 | 16 | 117 |
| 2017 Julio | 77 | 16 | 93 |
| 2017 Junio | 89 | 34 | 123 |
| 2017 Mayo | 203 | 19 | 222 |
| 2017 Abril | 63 | 22 | 85 |
| 2017 Marzo | 62 | 21 | 83 |
| 2017 Febrero | 84 | 18 | 102 |
| 2017 Enero | 36 | 14 | 50 |
| 2016 Diciembre | 64 | 21 | 85 |
| 2016 Noviembre | 87 | 27 | 114 |
| 2016 Octubre | 121 | 20 | 141 |
| 2016 Septiembre | 129 | 20 | 149 |
| 2016 Agosto | 90 | 20 | 110 |
| 2016 Julio | 38 | 10 | 48 |
| 2016 Junio | 10 | 15 | 25 |
| 2016 Mayo | 6 | 13 | 19 |
| 2016 Abril | 7 | 21 | 28 |
| 2016 Marzo | 8 | 20 | 28 |
| 2016 Febrero | 3 | 1 | 4 |
| 2016 Enero | 8 | 17 | 25 |
| 2015 Diciembre | 9 | 11 | 20 |
| 2015 Noviembre | 7 | 12 | 19 |
| 2015 Octubre | 18 | 10 | 28 |
| 2015 Septiembre | 8 | 10 | 18 |
| 2015 Agosto | 17 | 5 | 22 |
| 2015 Julio | 85 | 25 | 110 |
| 2015 Junio | 72 | 20 | 92 |
| 2015 Mayo | 66 | 38 | 104 |
| 2015 Abril | 68 | 31 | 99 |
| 2015 Marzo | 53 | 10 | 63 |
| 2015 Febrero | 56 | 16 | 72 |
| 2015 Enero | 66 | 14 | 80 |
| 2014 Diciembre | 54 | 19 | 73 |
| 2014 Noviembre | 30 | 11 | 41 |
| 2014 Octubre | 48 | 8 | 56 |
| 2014 Septiembre | 33 | 5 | 38 |
| 2014 Agosto | 35 | 5 | 40 |
| 2014 Julio | 33 | 5 | 38 |
| 2014 Junio | 36 | 2 | 38 |
| 2014 Mayo | 44 | 13 | 57 |
| 2014 Abril | 19 | 3 | 22 |
| 2014 Marzo | 20 | 4 | 24 |
| 2014 Febrero | 17 | 8 | 25 |
| 2014 Enero | 17 | 10 | 27 |
| 2013 Diciembre | 17 | 2 | 19 |
| 2013 Noviembre | 15 | 13 | 28 |
| 2013 Octubre | 15 | 11 | 26 |
| 2013 Septiembre | 13 | 8 | 21 |
| 2013 Agosto | 11 | 17 | 28 |
| 2013 Julio | 12 | 23 | 35 |
| 2013 Junio | 12 | 20 | 32 |
| 2013 Mayo | 12 | 16 | 28 |
| 2013 Abril | 18 | 9 | 27 |
| 2013 Marzo | 20 | 15 | 35 |
| 2013 Febrero | 30 | 7 | 37 |
| 2013 Enero | 82 | 8 | 90 |
| 2012 Diciembre | 39 | 3 | 42 |
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