Case and Research Letters
Clear Cell Acanthoma of the Areola and Nipple
Acantoma de células claras de la aréola y el pezón
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Hidalgo-García, P. Gonzálvo, S. Mallo-García, C. Fernández-Sánchez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Y." "apellidos" => "Hidalgo-García" "email" => array:1 [ 0 => "yhidalgog@yahoo.es" ] "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" => "P." "apellidos" => "Gonzálvo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Mallo-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Fernández-Sánchez" "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 de Cabueñes, Gijón, Asturias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital de Cabueñes, Gijón, Asturias, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Acantoma de células claras de la aréola y el pezón" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1155 "Ancho" => 851 "Tamanyo" => 124142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Well-defined, flaking, exudative erythematous plaque in the areola of the right breast. B, Complete resolution of the lesion in the areola of the right breast after 6 months of topical therapy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Clear-cell acanthoma was described by Degos et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> in 1962 as a benign epidermal tumor. It usually manifests clinically as a single, slow-growing, dome-shaped reddish papule or nodule with a peripheral desquamating collarette. The surface shows fine desquamation and a vascular pinpoint pattern and it has a tendency to bleed on minimal trauma. Clear-cell acanthoma usually arises on the distal areas of the legs of middle-aged or elderly persons, and its diameter varies between 5 and 20<span class="elsevierStyleHsp" style=""></span>mm.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> However, atypical sites and clinical forms and multiple lesions have been described, and even spontaneous regression.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2–4</span></a> This, together with its histological characteristics, has led to a discussion of whether it is a benign tumor or reactive hyperplasia secondary to chronic inflammation; even the term clear-cell acanthosis has been proposed.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Histology is characteristic, with a well-defined area of psoriasiform epidermal hyperplasia, in which the keratinocytes present a pale cytoplasm. There are interposed thick and thin layers, a tendency to acanthosis, particularly centrally, and fusion of the crests. In addition, mild spongiosis is observed, with neutrophil exocytosis, which can lead to the formation of small intraepidermal abscesses and thinning of the suprapapillary surfaces. The surface shows parakeratotic scales. Staining with periodic acid Schiff (PAS) confirms the presence of glycogen in the palisading cells.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Lesions arising in the areola of the breast have only been reported very rarely.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient was a 74-year-old woman with no family history of interest. Important findings in her personal past history were congenital hypothyroidism, systemic hypertension, dyslipidemia, and an ischemic stroke in 2012. Her long-term treatment included levothyroxine, simvastatin, omeprazole, enalapril, and acetylsalicylic acid. She did not report any personal history of atopic dermatitis or psoriasis. She was seen in dermatology outpatients for the appearance a year earlier of a reddish, exudative, desquamating lesion in the areola of the right breast. The lesion had bled occasionally. She had been treated with various topical corticosteroids, the names of which she did not remember, with no improvement. She had also been seen in the breast pathology unit of our hospital, and a mammography had been performed, which was reported as normal.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Dermatologic examination revealed the presence of a well-defined, desquamating erythematous plaque with a slightly shiny surface in the upper outer quadrant of the areola of the right breast (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The plaque measured 5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm. Biopsy was performed on a clinical suspicion of Paget disease. This showed psoriasiform hyperplasia of the epidermis with neutrophil exocytosis, thinning of the granular layer, and cells with abundant pale cytoplasm (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A); PAS staining is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B. The findings were compatible with clear-cell acanthoma.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Given the benign and asymptomatic nature of the lesion, we decided jointly with the patient and her family to adopt a wait-and-see approach. Treatment was started with 0.1% gentamicin sulfate plus 0.05% betamethasone dipropionate cream twice a day for 3 weeks. This achieved a marked improvement, and the treatment was therefore reduced to a single application twice a week, leading to complete resolution of the lesion after 6 months of treatment (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). No recurrence was observed in the 6 months after the interruption of treatment. The patient has not developed any other skin lesions during follow-up.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first reported case of clear-cell acanthoma localized in the areola was published by Kim et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> in 1999; their patient, who had a history of atopic dermatitis, presented with eczema. Since that time only 7 other cases of clear-cell acanthoma localized in the nipple or areola have been reported.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6–9</span></a> All have presented as eczematous lesions, except for the one published by Park et al.,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> which had a polypoid morphology. A history of atopy was found in 4 patients, including our patient, though other previous or concomitant dermatoses were not reported.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5–8</span></a> There is a clear female predominance at this site, with only 1 case occurring in a 26-year-old man.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> The size of the lesions varied between 2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm and 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6,9</span></a> The preferred treatment options have been surgery and cryotherapy, and no recurrences have been observed. Four cases, including the one we report, were treated with corticosteroids, observing complete resolution in our patient and in 1 patient who used 0.5% clobetasol cream twice a day for several weeks.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7,9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, we have presented a new case of clear-cell acanthoma in the areola and nipple, a rare site. We draw attention to the need to include this entity in the differential diagnosis of long-standing eczematous lesions of the nipple. The remission observed with a high-potency topical corticosteroid is a finding that supports the idea that clear-cell acanthoma may be a reactive process of the epidermis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => 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: Hidalgo-García Y, Gonzálvo P, Mallo-García S, Fernández-Sánchez C. Acantoma de células claras de la aréola y el pezón. Actas Dermosifiliogr. 2016;107:793–795.</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" => 1155 "Ancho" => 851 "Tamanyo" => 124142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Well-defined, flaking, exudative erythematous plaque in the areola of the right breast. B, Complete resolution of the lesion in the areola of the right breast after 6 months of topical therapy.</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" => 1437 "Ancho" => 951 "Tamanyo" => 548003 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Agranulosis, spongiosis, and neutrophil exocytosis with subcorneal microabscesses and sheets of parakeratosis. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×100. B, Cells with abundant, clear, periodic acid Schiff-positive cytoplasm. Periodic acid Schiff, original magnification<span class="elsevierStyleHsp" style=""></span>×80.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermal tumor with an unusual appearance: Clear cell acantoma [Article in French]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Degos" 1 => "J. Delort" 2 => "J. Civatte" 3 => "A. Polares Baptista" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Dermatol Syphiliogr (Paris)" "fecha" => "1962" "volumen" => "89" "paginaInicial" => "361" "paginaFinal" => "371" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clear cell acanthoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Tempark" 1 => "T. Shwayder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2230.2012.04428.x" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2012" "volumen" => "37" "paginaInicial" => "831" "paginaFinal" => "837" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23171155" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pale-cell acanthosis. A distinctive histologic pattern of epidermal epithelium" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Fukushiro" 1 => "Y. Takei" 2 => "A.B. Ackermann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "1985" "volumen" => "7" "paginaInicial" => "515" "paginaFinal" => "527" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4091227" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disseminated eruptive clear cell acanthoma with spontaneous regression: Further evidence of an inflammatory origin?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. García-Gavín" 1 => "D. González-Vilas" 2 => "I. Montero" 3 => "L. Rodríguez-Pazos" 4 => "M.M. Pereiro" 5 => "J. Toribio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0b013e3181f078e0" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2011" "volumen" => "33" "paginaInicial" => "599" "paginaFinal" => "602" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21317609" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of clear cell acanthoma presenting as nipple eczema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.H. Kim" 1 => "C.W. Kim" 2 => "S.J. Kang" 3 => "T.Y. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1999" "volumen" => "141" "paginaInicial" => "950" "paginaFinal" => "951" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10583200" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Three cases of clear cell acanthoma on nipple and areola" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.H. Um" 1 => "C.W. Oh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Korean J Dermatol" "fecha" => "2003" "volumen" => "41" "paginaInicial" => "85" "paginaFinal" => "88" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A 26-year-old man with an eczematous lesion on the nipple" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Nazzaro" 1 => "A. Cogí" 2 => "R. Gianotti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.148.5.642-b" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2012" "volumen" => "148" "paginaInicial" => "641" "paginaFinal" => "646" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23752346" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of polypoid clear cell acanthoma on the nipple" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.Y. Park" 1 => "J.Y. Jung" 2 => "J.I. Na" 3 => "H.J. Byun" 4 => "K.H. Cho" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5021/ad.2010.22.3.337" "Revista" => array:6 [ "tituloSerie" => "Ann Dermatol" "fecha" => "2010" "volumen" => "22" "paginaInicial" => "337" "paginaFinal" => "340" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20711275" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clear cell acanthoma of the areola and nipple: Clinical, histopathological, and immunohistochemical features of two Brazilian cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.R. Veiga" 1 => "R.S. Barros" 2 => "J.E. Santos" 3 => "J.M. Abreu Junior" 4 => "M.deJ. Bittencourt" 5 => "M.F. Miranda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2013" "volumen" => "88" "paginaInicial" => "84" "paginaFinal" => "89" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23539008" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109798004033" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000009/v1_201611010039/S1578219016302098/v1_201611010039/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/15782190/0000010700000009/v1_201611010039/S1578219016302098/v1_201611010039/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016302098?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 26 | 16 | 42 |
| 2024 Octubre | 106 | 77 | 183 |
| 2024 Septiembre | 103 | 35 | 138 |
| 2024 Agosto | 135 | 66 | 201 |
| 2024 Julio | 138 | 46 | 184 |
| 2024 Junio | 140 | 39 | 179 |
| 2024 Mayo | 118 | 43 | 161 |
| 2024 Abril | 99 | 30 | 129 |
| 2024 Marzo | 90 | 32 | 122 |
| 2024 Febrero | 148 | 37 | 185 |
| 2024 Enero | 91 | 36 | 127 |
| 2023 Diciembre | 106 | 12 | 118 |
| 2023 Noviembre | 136 | 35 | 171 |
| 2023 Octubre | 104 | 45 | 149 |
| 2023 Septiembre | 115 | 50 | 165 |
| 2023 Agosto | 139 | 18 | 157 |
| 2023 Julio | 168 | 74 | 242 |
| 2023 Junio | 245 | 47 | 292 |
| 2023 Mayo | 180 | 55 | 235 |
| 2023 Abril | 208 | 38 | 246 |
| 2023 Marzo | 237 | 46 | 283 |
| 2023 Febrero | 229 | 40 | 269 |
| 2023 Enero | 137 | 29 | 166 |
| 2022 Diciembre | 125 | 48 | 173 |
| 2022 Noviembre | 98 | 40 | 138 |
| 2022 Octubre | 78 | 29 | 107 |
| 2022 Septiembre | 74 | 26 | 100 |
| 2022 Agosto | 91 | 40 | 131 |
| 2022 Julio | 117 | 36 | 153 |
| 2022 Junio | 141 | 30 | 171 |
| 2022 Mayo | 195 | 43 | 238 |
| 2022 Abril | 165 | 34 | 199 |
| 2022 Marzo | 195 | 56 | 251 |
| 2022 Febrero | 200 | 43 | 243 |
| 2022 Enero | 245 | 48 | 293 |
| 2021 Diciembre | 162 | 38 | 200 |
| 2021 Noviembre | 117 | 43 | 160 |
| 2021 Octubre | 145 | 56 | 201 |
| 2021 Septiembre | 125 | 46 | 171 |
| 2021 Agosto | 108 | 24 | 132 |
| 2021 Julio | 70 | 33 | 103 |
| 2021 Junio | 125 | 39 | 164 |
| 2021 Mayo | 139 | 50 | 189 |
| 2021 Abril | 177 | 89 | 266 |
| 2021 Marzo | 131 | 23 | 154 |
| 2021 Febrero | 92 | 31 | 123 |
| 2021 Enero | 69 | 17 | 86 |
| 2020 Diciembre | 72 | 15 | 87 |
| 2020 Noviembre | 49 | 21 | 70 |
| 2020 Octubre | 55 | 22 | 77 |
| 2020 Septiembre | 74 | 8 | 82 |
| 2020 Agosto | 68 | 17 | 85 |
| 2020 Julio | 62 | 17 | 79 |
| 2020 Junio | 65 | 34 | 99 |
| 2020 Mayo | 51 | 9 | 60 |
| 2020 Abril | 61 | 17 | 78 |
| 2020 Marzo | 37 | 11 | 48 |
| 2020 Febrero | 8 | 0 | 8 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 8 | 0 | 8 |
| 2019 Noviembre | 2 | 0 | 2 |
| 2019 Septiembre | 8 | 0 | 8 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 7 | 1 | 8 |
| 2019 Abril | 3 | 7 | 10 |
| 2019 Marzo | 2 | 0 | 2 |
| 2019 Febrero | 7 | 0 | 7 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 10 | 0 | 10 |
| 2018 Noviembre | 5 | 0 | 5 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Febrero | 61 | 4 | 65 |
| 2018 Enero | 87 | 8 | 95 |
| 2017 Diciembre | 95 | 8 | 103 |
| 2017 Noviembre | 97 | 10 | 107 |
| 2017 Octubre | 89 | 14 | 103 |
| 2017 Septiembre | 75 | 51 | 126 |
| 2017 Agosto | 62 | 10 | 72 |
| 2017 Julio | 70 | 17 | 87 |
| 2017 Junio | 59 | 25 | 84 |
| 2017 Mayo | 42 | 9 | 51 |
| 2017 Abril | 28 | 15 | 43 |
| 2017 Marzo | 25 | 37 | 62 |
| 2017 Febrero | 84 | 22 | 106 |
| 2017 Enero | 28 | 14 | 42 |
| 2016 Diciembre | 42 | 24 | 66 |
| 2016 Noviembre | 52 | 32 | 84 |
| 2016 Octubre | 5 | 6 | 11 |
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