Case and Research Letters
Fabry Disease and the Clinical Spectrum of Angiokeratomas
Enfermedad de Fabry: espectro clínico de los angioqueratomas
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Guinovart, I. Bielsa, G. Pintos-Morell, C. Ferrándiz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "R.M." "apellidos" => "Guinovart" "email" => array:1 [ 0 => "rosa_guinovart@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" => "I." "apellidos" => "Bielsa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Pintos-Morell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Ferrándiz" "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 Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad de Fabry: espectro clínico de los angioqueratomas" ] ] "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" => 1747 "Ancho" => 1335 "Tamanyo" => 399512 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Angiokeratomas on the left side of the vulva (patient #2).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">After Gaucher disease, Fabry disease is the most common storage disease caused by the progressive accumulation of glycosphingolipids in multiple organs. Clinical presentation is very varied, and furthermore, the manifestations in many of the organs affected are nonspecific.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Diagnosis is thus challenging and often delayed. The average time from onset of symptoms to a diagnosis of Fabry disease is around 10 years.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Cutaneous involvement is common and is one of the key signs that can lead a physician to suspect the disease. Skin manifestations include angiokeratomas, telangiectasias, abnormal sweating, and lymphedema. Recent studies of cutaneous involvement in Fabry disease have shown that the clinical spectrum of angiokeratomas is also varied.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> We performed a retrospective review of skin lesions in 5 patients (4 males and 1 female) with Fabry disease, with a particular focus on the clinical variants of angiokeratomas. The main clinical features are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The majority of patients, including the only woman, had classic extracutaneous manifestations. The mean age at onset of angiokeratomas was 17.2 years. Patients #4 and #5 had a classic bathing trunk appearance, and patient #5 also had less hyperkeratotic vascular lesions on the palms of both hands. The other 3 patients had less characteristic angiokeratomas. Patient #1 had small, isolated lesions around the mouth and the umbilicus (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), while patient #3 had extensive angiokeratomas distributed almost exclusively on the left side of the body. Finally, patient #2, who was heterozygous, had lesions in the form of angiokeratomas on the left side of the vulva (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and small isolated lesions on the anterior surface of the trunk. Just 2 of the patients had hypohidrosis. With the exception of patient #1, all the patients were receiving enzyme replacement treatment, with a mean uninterrupted treatment period of 9 years; there had been no signs of the angiokeratomas disappearing or becoming smaller or any improvements in the other skin manifestations.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Angiokeratoma corporis diffusum is one of the 5 known types of angiokeratoma.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It is highly characteristic of Fabry disease, but can also be seen in other lysosomal storage diseases.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> Angiokeratomas, which can appear in childhood or adulthood, develop in 66% of male patients with Fabry disease and in 36% of female patients.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> While the term <span class="elsevierStyleItalic">angiokeratoma corporis diffusum</span> suggests the presence of multiple angiokeratomas, this is not always the case. Furthermore, as seen in 3 of the 5 cases we describe, the lesions can appear in isolation or in clusters and can affect any part of the skin, mucous membranes, or genitals. Angiokeratomas classically occur in a bathing trunk distribution, referred to as such because the lesions typically affect the buttocks, the thighs, and the genitals. Of particular interest in our series was the unilateral, left-sided, distribution observed in 1 patient and the presence of small lesions in 2 patients (around the mouth and the umbilicus in one case and on the genital mucosa in the other). The detection of angiokeratomas on the genital mucosa can erroneously lead to a diagnosis of angiokeratoma of Fordyce.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The diagnosis of Fabry disease in a patient with lesions in less common sites is more difficult, but physicians should maintain a high level of clinical suspicion. While manifestations of the disease generally appear after the first decade of life, with acroparesthesia, angiokeratomas, exercise intolerance, and eye and gastrointestinal disorders, the main complications appear in young adults, who develop renal, cardiac, and cerebrovascular signs and symptoms. Considering that specific treatment is available for Fabry disease, early diagnosis (often based on the detection of angiokeratomas) is important, as timely treatment can prevent the development of serious, irreversible complications. Dermatologists can play a key role in this respect.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Enzyme replacement therapy (with agalsidase alpha) is the only specific treatment available for Fabry disease, and has been shown to stabilize renal function and reduce left ventricular hypertrophy.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a> In our series, treatment did not improve any of the skin manifestations present before treatment initiation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, the detection of angiokeratomas, regardless of their location or distribution, should alert the dermatologist to a possible diagnosis of Fabry disease and prompt the performance of relevant tests to confirm or rule out this serious, treatable disease. Young relatives of newly diagnosed patients should also be studied, with a particular focus on symptoms that may have been missed or interpreted incorrectly.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Guinovart RM, et al. Enfermedad de Fabry: espectro clínico de los angioqueratomas. Actas Dermosifiliogr. 2013;104:261–3.</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" => 1247 "Ancho" => 1667 "Tamanyo" => 204153 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Small lesions in the form of angiokeratomas around the umbilicus (patient #1).</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" => 1747 "Ancho" => 1335 "Tamanyo" => 399512 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Angiokeratomas on the left side of the vulva (patient #2).</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">Abbreviations: ERT, enzyme replacement therapy; 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"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sex (M/F)/Age, y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Extracutaneous Manifestations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Location of Angiokeratomas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Age at Onset of Angiokeratomas, y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Duration of ERT, y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Other Skin Manifestations \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Exercise intoleranceCornea verticillata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Around mouth and umbilicus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F/36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AcroparesthesiaExercise intoleranceTinnitusDiarrheaCornea verticillata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left lumbar region, vulva \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypohidrosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">3</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AcroparesthesiaExercise intoleranceTinnitusAbdominal painCornea verticillata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left body \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">4</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left ventricular hypertrophyProteinuriaExercise intoleranceDiarrhea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Flank, waist, and medial aspect of thighs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypohidrosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">5</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AcroparesthesiaVascular tortuosity in both eyes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thighs, buttocks, genitals, and palms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183298.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical Findings.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 15 | 27 |
| 2024 Octubre | 157 | 57 | 214 |
| 2024 Septiembre | 194 | 57 | 251 |
| 2024 Agosto | 238 | 70 | 308 |
| 2024 Julio | 218 | 72 | 290 |
| 2024 Junio | 178 | 54 | 232 |
| 2024 Mayo | 152 | 58 | 210 |
| 2024 Abril | 128 | 26 | 154 |
| 2024 Marzo | 134 | 60 | 194 |
| 2024 Febrero | 116 | 48 | 164 |
| 2024 Enero | 102 | 54 | 156 |
| 2023 Diciembre | 103 | 35 | 138 |
| 2023 Noviembre | 110 | 40 | 150 |
| 2023 Octubre | 123 | 41 | 164 |
| 2023 Septiembre | 105 | 35 | 140 |
| 2023 Agosto | 62 | 23 | 85 |
| 2023 Julio | 84 | 54 | 138 |
| 2023 Junio | 90 | 41 | 131 |
| 2023 Mayo | 90 | 40 | 130 |
| 2023 Abril | 78 | 33 | 111 |
| 2023 Marzo | 45 | 51 | 96 |
| 2023 Febrero | 46 | 30 | 76 |
| 2023 Enero | 49 | 47 | 96 |
| 2022 Diciembre | 63 | 52 | 115 |
| 2022 Noviembre | 31 | 42 | 73 |
| 2022 Octubre | 56 | 30 | 86 |
| 2022 Septiembre | 39 | 50 | 89 |
| 2022 Agosto | 40 | 41 | 81 |
| 2022 Julio | 44 | 43 | 87 |
| 2022 Junio | 41 | 33 | 74 |
| 2022 Mayo | 55 | 46 | 101 |
| 2022 Abril | 104 | 46 | 150 |
| 2022 Marzo | 84 | 65 | 149 |
| 2022 Febrero | 54 | 29 | 83 |
| 2022 Enero | 59 | 36 | 95 |
| 2021 Diciembre | 49 | 54 | 103 |
| 2021 Noviembre | 61 | 46 | 107 |
| 2021 Octubre | 66 | 66 | 132 |
| 2021 Septiembre | 57 | 50 | 107 |
| 2021 Agosto | 33 | 29 | 62 |
| 2021 Julio | 43 | 54 | 97 |
| 2021 Junio | 45 | 46 | 91 |
| 2021 Mayo | 37 | 35 | 72 |
| 2021 Abril | 79 | 65 | 144 |
| 2021 Marzo | 68 | 27 | 95 |
| 2021 Febrero | 67 | 22 | 89 |
| 2021 Enero | 39 | 23 | 62 |
| 2020 Diciembre | 38 | 16 | 54 |
| 2020 Noviembre | 35 | 11 | 46 |
| 2020 Octubre | 44 | 14 | 58 |
| 2020 Septiembre | 54 | 9 | 63 |
| 2020 Agosto | 32 | 23 | 55 |
| 2020 Julio | 28 | 20 | 48 |
| 2020 Junio | 48 | 26 | 74 |
| 2020 Mayo | 29 | 22 | 51 |
| 2020 Abril | 30 | 30 | 60 |
| 2020 Marzo | 28 | 18 | 46 |
| 2020 Febrero | 6 | 11 | 17 |
| 2020 Enero | 0 | 14 | 14 |
| 2019 Diciembre | 0 | 7 | 7 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 1 | 3 | 4 |
| 2019 Julio | 0 | 2 | 2 |
| 2019 Junio | 0 | 21 | 21 |
| 2019 Mayo | 4 | 37 | 41 |
| 2019 Abril | 0 | 18 | 18 |
| 2019 Marzo | 0 | 14 | 14 |
| 2019 Enero | 1 | 1 | 2 |
| 2018 Diciembre | 0 | 2 | 2 |
| 2018 Noviembre | 1 | 1 | 2 |
| 2018 Octubre | 1 | 2 | 3 |
| 2018 Septiembre | 4 | 4 | 8 |
| 2018 Agosto | 0 | 13 | 13 |
| 2018 Julio | 0 | 8 | 8 |
| 2018 Junio | 0 | 11 | 11 |
| 2018 Mayo | 0 | 13 | 13 |
| 2018 Abril | 0 | 8 | 8 |
| 2018 Marzo | 1 | 10 | 11 |
| 2018 Febrero | 40 | 11 | 51 |
| 2018 Enero | 67 | 13 | 80 |
| 2017 Diciembre | 89 | 12 | 101 |
| 2017 Noviembre | 57 | 10 | 67 |
| 2017 Octubre | 70 | 20 | 90 |
| 2017 Septiembre | 50 | 64 | 114 |
| 2017 Agosto | 48 | 17 | 65 |
| 2017 Julio | 28 | 41 | 69 |
| 2017 Junio | 53 | 25 | 78 |
| 2017 Mayo | 42 | 26 | 68 |
| 2017 Abril | 41 | 29 | 70 |
| 2017 Marzo | 32 | 24 | 56 |
| 2017 Febrero | 40 | 17 | 57 |
| 2017 Enero | 40 | 24 | 64 |
| 2016 Diciembre | 65 | 8 | 73 |
| 2016 Noviembre | 81 | 7 | 88 |
| 2016 Octubre | 117 | 22 | 139 |
| 2016 Septiembre | 101 | 18 | 119 |
| 2016 Agosto | 90 | 4 | 94 |
| 2016 Julio | 58 | 8 | 66 |
| 2016 Junio | 8 | 13 | 21 |
| 2016 Mayo | 4 | 6 | 10 |
| 2016 Abril | 6 | 8 | 14 |
| 2016 Marzo | 3 | 1 | 4 |
| 2016 Febrero | 4 | 8 | 12 |
| 2016 Enero | 9 | 1 | 10 |
| 2015 Diciembre | 7 | 0 | 7 |
| 2015 Noviembre | 8 | 2 | 10 |
| 2015 Octubre | 4 | 2 | 6 |
| 2015 Septiembre | 5 | 1 | 6 |
| 2015 Agosto | 8 | 0 | 8 |
| 2015 Julio | 69 | 110 | 179 |
| 2015 Junio | 61 | 12 | 73 |
| 2015 Mayo | 88 | 11 | 99 |
| 2015 Abril | 102 | 28 | 130 |
| 2015 Marzo | 38 | 2 | 40 |
| 2015 Febrero | 33 | 12 | 45 |
| 2015 Enero | 41 | 11 | 52 |
| 2014 Diciembre | 51 | 4 | 55 |
| 2014 Noviembre | 25 | 3 | 28 |
| 2014 Octubre | 42 | 6 | 48 |
| 2014 Septiembre | 46 | 4 | 50 |
| 2014 Agosto | 46 | 5 | 51 |
| 2014 Julio | 38 | 7 | 45 |
| 2014 Junio | 67 | 5 | 72 |
| 2014 Mayo | 54 | 11 | 65 |
| 2014 Abril | 51 | 5 | 56 |
| 2014 Marzo | 51 | 12 | 63 |
| 2014 Febrero | 46 | 12 | 58 |
| 2014 Enero | 61 | 6 | 67 |
| 2013 Diciembre | 59 | 12 | 71 |
| 2013 Noviembre | 60 | 9 | 69 |
| 2013 Octubre | 448 | 7 | 455 |
| 2013 Septiembre | 951 | 5 | 956 |
| 2013 Agosto | 781 | 4 | 785 |
| 2013 Julio | 140 | 6 | 146 |
| 2013 Junio | 2 | 8 | 10 |
| 2013 Mayo | 4 | 5 | 9 |
| 2013 Abril | 5 | 6 | 11 |
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