Case for Diagnosis
Ulcer on the Scrotum
Úlcera en el escroto
L.C. Arango-Duque
, S. Blanco-Barrios, E. Fernández-López
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Servicio de Dermatología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
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8621
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"apellidos" => "Fernández-López" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Úlcera en el escroto" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1287 "Ancho" => 1669 "Tamanyo" => 319596 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was an 81-year-old man with a history of stage A chronic lymphocytic leukemia, ischemic heart disease, and rheumatoid arthritis for which he was taking methotrexate (7.5<span class="elsevierStyleHsp" style=""></span>mg per week), prednisone, and diclofenac.</p><p id="par0010" class="elsevierStylePara elsevierViewall">He consulted because of a painful ulcer on the scrotum that had first appeared a few weeks previously and was treated with topical silver sulfadiazine. One month later, the lesion had worsened, as had the patient's general status, with fever, dyspnea, mucocutaneous pallor, and enlarged axillary and inguinal lymph nodes.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed an ulcer on the scrotum. It measured 2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm and had slightly infiltrated borders and a fibrin-covered base (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0020" class="elsevierStylePara elsevierViewall">Histopathology of the skin biopsy specimen revealed minimal hyperkeratosis in the epidermis and, at a deeper level, an area of geographic necrosis surrounded by an intense mixed inflammatory component comprising mainly lymphocytes and monocytes with plasma cells, histiocytes, and eosinophils. No granulomatous infiltrations were observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0025" class="elsevierStylePara elsevierViewall">Laboratory analysis revealed pancytopenia, impaired renal function, and increased lactate dehydrogenase and C-reactive protein levels. Culture of exudates from the ulcer and tissue were negative.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What is Your Diagnosis?</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Cutaneous ulcer secondary to methotrexate.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Methotrexate was suspended, and intravenous folic acid was administered.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The complete blood count values gradually returned to normal, with progressive resolution of the ulcer. One month later, the ulcer had re-epithelialized completely (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0050" class="elsevierStylePara elsevierViewall">Methotrexate is a synthetic analog of folic acid that is used as a chemotherapy agent and for the treatment of inflammatory diseases.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The most common adverse reactions include gastrointestinal discomfort, joint and muscle pain, and general malaise, which are usually dose-dependent and can be attenuated with folic acid. More severe side effects, such as liver and blood disorders, can also be observed.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Relatively common cutaneous adverse effects include stomatitis and mouth ulcers, which are usually early markers of toxicity. Other skin disorders, such as photosensitivity, exanthema, vasculitis, erythema, scaling, and toxic epidermic necrolysis,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> are rare and appear at high doses of methotrexate.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Skin ulcers, unlike mucosal ulcers, are an uncommon side effect<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> that has been reported mainly in patients with psoriasis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> They are exceptional in patients with no history of this psoriasis, and few cases have been reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> Cutaneous ulcer with pancytopenia is considered a sign of drug toxicity.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">A literature review by Pearce and Wilson<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> between 1967-1996 revealed that only 17 patients had experienced this side effect.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Lawrence et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> divided these skin ulcers into 2 types: type I ulcers, which present as necrosis of the psoriatic plaques, and type II ulcers, which are found on skin not affected by psoriasis but by previous disorders or concurrent conditions such as stasis dermatitis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Direct toxicity seemed to be the underlying mechanism in both types.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,8</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The results of the histopathology study are usually nonspecific, although there have been reports of changes resulting from epidermal dysmaturation and eccrine squamous syringometaplasia.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The main risk factors associated with methotrexate-induced ulcers include changes in dose, concomitant therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), renal failure, concomitant infections, outbreaks of pustular psoriasis, and advanced age.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The occurrence of this and other adverse effects stresses the need for long-term follow-up in patients receiving methotrexate, even at low, stable doses. Medication, especially NSAIDs, and renal failure can boost the toxicity of methotrexate.</p><p id="par0090" class="elsevierStylePara elsevierViewall">We report a new case of skin ulcer secondary to treatment with methotrexate accompanied by pancytopenia in a patient not diagnosed with psoriasis. The pathogenic mechanism seemed to be multifactorial, and age, lack of folic acid, NSAIDs, and renal impairment all seemed to play a role.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of Interest" ] 8 => 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: Arango-Duque LC, Blanco-Barrios S, Fernández-López E. Úlcera en el escroto. Actas Dermosifiliogr. 2014;105:515–516.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1287 "Ancho" => 1669 "Tamanyo" => 319596 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1230 "Ancho" => 1669 "Tamanyo" => 364765 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin. A, original magnification ×<span class="elsevierStyleHsp" style=""></span>20. B, original magnification ×<span class="elsevierStyleHsp" style=""></span>40. C, original magnification ×<span class="elsevierStyleHsp" style=""></span>200.</p>" ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1316 "Ancho" => 1669 "Tamanyo" => 379691 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of methotrexate in dermatology: A review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Shen" 1 => "T. O’Brien" 2 => "L. Mee Yap" 3 => "H. Miles Prince" 4 => "C.J. McCormack" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Australas J Dermatol" "fecha" => "2012" "volumen" => "53" "paginaInicial" => "1" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22629556" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous ulceration: An unusual sign of methotrexate toxicity. First report in a patient without psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Ben-Amitai" 1 => "E. Hodak" 2 => "M. David" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Pharmacother" "fecha" => "1998" "volumen" => "32" "paginaInicial" => "651" "paginaFinal" => "653" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9640483" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Toxicodermia por metotrexato con marcada dismaduración epidérmica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. García de Villalta" 1 => "D. Ruiz-Genao" 2 => "S. Álvarez-Ruiz" 3 => "M. Aragüés" 4 => "J. Fraga" 5 => "J. Fernández-Herrera" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2004" "volumen" => "95" "paginaInicial" => "567" "paginaFinal" => "570" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous ulceration caused by methotrexate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.W. Kazlow" 1 => "D. Federgrun" 2 => "S. Kurtin" 3 => "M.G. Lebwohl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2003" "volumen" => "49" "paginaInicial" => "197" "paginaFinal" => "198" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early-onset pancytopenia and skin ulcer following low-dose methotrexate therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Hocaoglu" 1 => "R. Atilla" 2 => "F. Onen" 3 => "Y. Tuncok" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0960327108094507" "Revista" => array:6 [ "tituloSerie" => "Hum Exp Toxicol" "fecha" => "2008" "volumen" => "27" "paginaInicial" => "585" "paginaFinal" => "589" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18829735" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methotrexate-induced cutaneous ulcers in a nonpsoriatic patient: Case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Kurian" 1 => "R. Haber" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Cutan Med Surg" "fecha" => "2011" "volumen" => "15" "paginaInicial" => "275" "paginaFinal" => "279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21962187" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erosion of psoriatic plaques: Methotrexate toxicity. An early sign of methotrexate toxicity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.P. Pearce" 1 => "B. Braunstein Wilson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1996" "volumen" => "35" "paginaInicial" => "835" "paginaFinal" => "838" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8912599" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Two patterns of skin ulceration induced by methotrexate in patients with psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.M. Lawrence" 1 => "M.G.C. Dahl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1984" "volumen" => "11" "paginaInicial" => "1059" "paginaFinal" => "1065" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6512051" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000005/v1_201405281018/S1578219014001218/v1_201405281018/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010500000005/v1_201405281018/S1578219014001218/v1_201405281018/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014001218?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 13 | 8 | 21 |
| 2024 Octubre | 120 | 63 | 183 |
| 2024 Septiembre | 149 | 40 | 189 |
| 2024 Agosto | 180 | 53 | 233 |
| 2024 Julio | 185 | 47 | 232 |
| 2024 Junio | 154 | 36 | 190 |
| 2024 Mayo | 99 | 36 | 135 |
| 2024 Abril | 104 | 30 | 134 |
| 2024 Marzo | 85 | 31 | 116 |
| 2024 Febrero | 82 | 27 | 109 |
| 2024 Enero | 77 | 40 | 117 |
| 2023 Diciembre | 48 | 23 | 71 |
| 2023 Noviembre | 67 | 39 | 106 |
| 2023 Octubre | 55 | 31 | 86 |
| 2023 Septiembre | 55 | 31 | 86 |
| 2023 Agosto | 39 | 23 | 62 |
| 2023 Julio | 50 | 51 | 101 |
| 2023 Junio | 63 | 37 | 100 |
| 2023 Mayo | 58 | 38 | 96 |
| 2023 Abril | 50 | 29 | 79 |
| 2023 Marzo | 36 | 36 | 72 |
| 2023 Febrero | 45 | 43 | 88 |
| 2023 Enero | 45 | 25 | 70 |
| 2022 Diciembre | 53 | 44 | 97 |
| 2022 Noviembre | 45 | 45 | 90 |
| 2022 Octubre | 38 | 27 | 65 |
| 2022 Septiembre | 25 | 55 | 80 |
| 2022 Agosto | 24 | 52 | 76 |
| 2022 Julio | 27 | 51 | 78 |
| 2022 Junio | 28 | 38 | 66 |
| 2022 Mayo | 51 | 45 | 96 |
| 2022 Abril | 48 | 40 | 88 |
| 2022 Marzo | 50 | 66 | 116 |
| 2022 Febrero | 48 | 37 | 85 |
| 2022 Enero | 61 | 68 | 129 |
| 2021 Diciembre | 41 | 74 | 115 |
| 2021 Noviembre | 58 | 61 | 119 |
| 2021 Octubre | 43 | 96 | 139 |
| 2021 Septiembre | 27 | 61 | 88 |
| 2021 Agosto | 47 | 69 | 116 |
| 2021 Julio | 36 | 58 | 94 |
| 2021 Junio | 34 | 43 | 77 |
| 2021 Mayo | 30 | 91 | 121 |
| 2021 Abril | 67 | 173 | 240 |
| 2021 Marzo | 66 | 86 | 152 |
| 2021 Febrero | 76 | 109 | 185 |
| 2021 Enero | 40 | 108 | 148 |
| 2020 Diciembre | 42 | 75 | 117 |
| 2020 Noviembre | 29 | 73 | 102 |
| 2020 Octubre | 29 | 41 | 70 |
| 2020 Septiembre | 20 | 56 | 76 |
| 2020 Agosto | 25 | 61 | 86 |
| 2020 Julio | 20 | 49 | 69 |
| 2020 Junio | 40 | 64 | 104 |
| 2020 Mayo | 35 | 63 | 98 |
| 2020 Abril | 33 | 112 | 145 |
| 2020 Marzo | 34 | 100 | 134 |
| 2020 Febrero | 5 | 76 | 81 |
| 2020 Enero | 4 | 48 | 52 |
| 2019 Diciembre | 8 | 45 | 53 |
| 2019 Noviembre | 4 | 15 | 19 |
| 2019 Octubre | 0 | 10 | 10 |
| 2019 Septiembre | 12 | 8 | 20 |
| 2019 Agosto | 4 | 7 | 11 |
| 2019 Julio | 2 | 22 | 24 |
| 2019 Junio | 7 | 23 | 30 |
| 2019 Mayo | 2 | 63 | 65 |
| 2019 Abril | 0 | 48 | 48 |
| 2019 Marzo | 2 | 15 | 17 |
| 2019 Febrero | 0 | 11 | 11 |
| 2019 Enero | 1 | 8 | 9 |
| 2018 Diciembre | 0 | 8 | 8 |
| 2018 Noviembre | 3 | 8 | 11 |
| 2018 Octubre | 6 | 0 | 6 |
| 2018 Septiembre | 1 | 8 | 9 |
| 2018 Agosto | 0 | 12 | 12 |
| 2018 Julio | 0 | 16 | 16 |
| 2018 Junio | 0 | 12 | 12 |
| 2018 Mayo | 0 | 5 | 5 |
| 2018 Abril | 0 | 4 | 4 |
| 2018 Marzo | 2 | 4 | 6 |
| 2018 Febrero | 18 | 6 | 24 |
| 2018 Enero | 27 | 20 | 47 |
| 2017 Diciembre | 38 | 6 | 44 |
| 2017 Noviembre | 27 | 15 | 42 |
| 2017 Octubre | 24 | 29 | 53 |
| 2017 Septiembre | 28 | 9 | 37 |
| 2017 Agosto | 43 | 11 | 54 |
| 2017 Julio | 29 | 20 | 49 |
| 2017 Junio | 47 | 35 | 82 |
| 2017 Mayo | 37 | 28 | 65 |
| 2017 Abril | 43 | 13 | 56 |
| 2017 Marzo | 30 | 18 | 48 |
| 2017 Febrero | 28 | 20 | 48 |
| 2017 Enero | 21 | 16 | 37 |
| 2016 Diciembre | 47 | 16 | 63 |
| 2016 Noviembre | 57 | 19 | 76 |
| 2016 Octubre | 57 | 26 | 83 |
| 2016 Septiembre | 61 | 18 | 79 |
| 2016 Agosto | 59 | 18 | 77 |
| 2016 Julio | 41 | 14 | 55 |
| 2016 Junio | 9 | 5 | 14 |
| 2016 Mayo | 5 | 2 | 7 |
| 2016 Abril | 10 | 1 | 11 |
| 2016 Marzo | 6 | 1 | 7 |
| 2016 Febrero | 14 | 3 | 17 |
| 2016 Enero | 13 | 2 | 15 |
| 2015 Diciembre | 16 | 2 | 18 |
| 2015 Noviembre | 10 | 4 | 14 |
| 2015 Octubre | 15 | 18 | 33 |
| 2015 Septiembre | 7 | 2 | 9 |
| 2015 Agosto | 16 | 6 | 22 |
| 2015 Julio | 54 | 12 | 66 |
| 2015 Junio | 39 | 6 | 45 |
| 2015 Mayo | 30 | 9 | 39 |
| 2015 Abril | 18 | 4 | 22 |
| 2015 Marzo | 26 | 2 | 28 |
| 2015 Febrero | 18 | 1 | 19 |
| 2015 Enero | 20 | 7 | 27 |
| 2014 Diciembre | 29 | 1 | 30 |
| 2014 Noviembre | 22 | 10 | 32 |
| 2014 Octubre | 23 | 10 | 33 |
| 2014 Septiembre | 16 | 3 | 19 |
| 2014 Agosto | 21 | 12 | 33 |
| 2014 Julio | 18 | 8 | 26 |
| 2014 Junio | 28 | 5 | 33 |
| 2014 Mayo | 4 | 3 | 7 |
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