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Os primeiros&#44; em geral&#44; decorrem do uso de alisantes &#225;cidos&#44; t&#234;m durabilidade vari&#225;vel e podem ter efeito cumulativo com aplica&#231;&#245;es sucessivas&#46; J&#225; os definitivos s&#227;o permanentes na &#225;rea do fio tratada e&#44; via de regra&#44; s&#227;o obtidos por meio de subst&#226;ncias alcalinas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Diversos compostos s&#227;o utilizados pela popula&#231;&#227;o para obter alisamento qu&#237;mico&#44; independentemente de sua libera&#231;&#227;o pela legisla&#231;&#227;o&#46; No Brasil&#44; a t&#233;cnica chamada de &#8220;escova progressiva&#8221; se difundiu com a utiliza&#231;&#227;o de alisantes &#225;cidos como o formalde&#237;do e o glutaralde&#237;do&#46; O procedimento foi disseminado mundialmente como tratamento brasileiro de queratina&#44; entre outras denomina&#231;&#245;es&#46; O formalde&#237;do &#233; classificado como uma subst&#226;ncia incolor&#44; altamente t&#243;xica e que&#44; 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utilizam &#225;cido gliox&#237;lico associado a carbociste&#237;na ou amino&#225;cidos&#44; derivados de silicone e &#225;cidos graxos&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A Instru&#231;&#227;o Normativa IN n&#176; 64<span class="elsevierStyleHsp" style=""></span>da Anvisa de 27&#47;07&#47;2020 estabeleceu&#44; nos termos da Resolu&#231;&#227;o de Diretoria Colegiada &#40;RDC&#41; n&#176; 409&#44; sua &#8220;Lista de ativos permitidos em produtos cosm&#233;ticos para alisar ou ondular os cabelos&#8221;&#44; onde constam&#58; &#225;cido tioglic&#243;lico e seus sais&#44; &#233;steres de &#225;cido tioglic&#243;lico&#44; hidr&#243;xido de s&#243;dio ou pot&#225;ssio&#44; hidr&#243;xido de l&#237;tio&#44; hidr&#243;xido de c&#225;lcio associado a sal de guanidina&#44; sulfitos e bissulfitos inorg&#226;nicos&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">10</span></a> Esses s&#227;o os alisantes tradicionais&#44; comumente referidos como relaxantes&#46; Embora existam diverg&#234;ncias&#44; de modo geral essa denomina&#231;&#227;o &#233; usada para designar os alisantes alcalinos&#46; Eles podem ser classificados em <span class="elsevierStyleItalic">lye</span> &#40;&#224; base de hidr&#243;xido de s&#243;dio&#41;&#44; <span class="elsevierStyleItalic">no&#8208;lye</span>&#44; tioglicolato de am&#244;nia e bissulfitos&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">3</span></a> Os hidr&#243;xidos s&#227;o divididos em <span class="elsevierStyleItalic">lye</span> e <span class="elsevierStyleItalic">no&#8208;lye</span>&#46; Alguns autores categorizam o tioglicolato no grupo dos <span class="elsevierStyleItalic">no&#8208;lye</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">O presente artigo tem como objetivo identificar as altera&#231;&#245;es na haste capilar e no couro cabeludo provocadas pelo uso de alisantes qu&#237;micos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Foi realizada busca nas bases de dados Pubmed&#44; Lilacs e Scielo usando os termos <span class="elsevierStyleItalic">hair straightening&#44; brazilian hair treatment&#44; brazilian blowout&#44; hair relaxer&#44; formaldehyde hair&#44; glyoxylic acid hair&#44; thioglycolic hair&#44; sodium hydroxide hair&#44; calcium hydroxide hair&#44; guanidine hair&#44; potassium hydroxide hair&#44; lithium hydroxide hair</span>&#44; alisamento cabelo&#44; escova progressiva&#44; relaxamento cabelo&#44; formalde&#237;do cabelo&#44; &#225;cido gliox&#237;lico cabelo&#44; tioglicolato cabelo&#44; hidr&#243;xido de s&#243;dio cabelo&#44; hidr&#243;xido de c&#225;lcio cabelo&#44; guanidina cabelo&#44; hidr&#243;xido de pot&#225;ssio cabelo&#44; hidr&#243;xido de l&#237;tio cabelo&#46; Foram inclu&#237;das publica&#231;&#245;es entre janeiro de 2000 a maio de 2020&#46; O per&#237;odo de busca da pesquisa foi de 16&#47;03&#47;2020 a 20&#47;05&#47;2020&#46; Obtiveram&#8208;se 703 resultados&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">O crit&#233;rio para inclus&#227;o dos artigos foi a tem&#225;tica de alisantes capilares e seus efeitos em couro cabeludo e haste capilar&#46; Foram exclu&#237;dos todos os resultados sem rela&#231;&#227;o com alisantes capilares&#44; pela leitura dos t&#237;tulos dos artigos&#46; A partir dos resumos dos artigos&#44; foram exclu&#237;dos artigos de revis&#227;o&#44; g&#234;nero cartas a editor e teses de doutorado &#40;inclu&#237;dos artigos decorrentes dessas teses publicados em revistas cient&#237;ficas&#41;&#46; Tamb&#233;m foram exclu&#237;dos artigos sobre o termo &#8220;permanente&#8221; pois&#44; apesar de as subst&#226;ncias se sobreporem aos alisantes qu&#237;micos&#44; a t&#233;cnica consiste em passos diferentes&#46; Exclu&#237;ram&#8208;se artigos referentes &#224; exposi&#231;&#227;o ocupacional &#224;s subst&#226;ncias qu&#237;micas dos alisantes e publica&#231;&#245;es que realizaram an&#225;lise das formula&#231;&#245;es sem investigar seus efeitos em haste ou couro cabeludo&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Estudos referentes a outras t&#233;cnicas capilares s&#243; deixaram de ser exclu&#237;dos quando as informa&#231;&#245;es se mesclavam &#224;s dos alisantes &#40;por exemplo&#58; associa&#231;&#227;o de t&#233;cnicas&#41; ou quando os alisamentos eram um dos assuntos estudados &#40;nesse caso&#44; a revis&#227;o englobou apenas as informa&#231;&#245;es sobre os alisantes&#41;&#46; Quando o artigo tratava conjuntamente de efeitos pesquisados e de efeitos colaterais sist&#234;micos&#44; os &#250;ltimos n&#227;o foram detalhados na revis&#227;o&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Portanto&#44; ap&#243;s a aplica&#231;&#227;o dos crit&#233;rios de inclus&#227;o e exclus&#227;o&#44; 649 artigos foram exclu&#237;dos&#46; A busca resultou em 33 artigos&#44; ap&#243;s a remo&#231;&#227;o de duplicatas&#44; selecionados para leitura e revis&#227;o&#46; Os m&#233;todos encontram&#8208;se esquematizados na <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Alisantes &#225;cidos&#58; formalde&#237;do&#44; outros alde&#237;dos e derivados do formalde&#237;do</span><p id="par0050" class="elsevierStylePara elsevierViewall">O formalde&#237;do pode causar dermatite de contato al&#233;rgica com gravidade progressiva a cada reexposi&#231;&#227;o&#44; com manifesta&#231;&#227;o cl&#237;nica de eczema em couro cabeludo e regi&#245;es adjacentes e edema em face&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Casos de eczema psoriasiforme em couro cabeludo&#44; face&#44; pesco&#231;o e tronco superior&#44; ocasionalmente com p&#250;stulas&#44; foram relatados ap&#243;s tratamento com escova de queratina brasileira&#46; A dermatoscopia revelou eritema e descama&#231;&#227;o interfolicular e perifolicular&#44; e a histopatologia demonstrou padr&#245;es psoriasiforme e espongi&#243;tico&#46; Aventou&#8208;se a possibilidade de que o formalde&#237;do n&#227;o cause les&#245;es apenas por dermatite de contato al&#233;rgica ou por irritante prim&#225;rio&#44; mas possa induzir rea&#231;&#245;es por outros mecanismos&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">13</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Quanto &#224;s altera&#231;&#245;es na haste capilar&#44; uma an&#225;lise comparativa das propriedades mec&#226;nicas dos fios ap&#243;s tratamento com formalde&#237;do e &#225;cido gliox&#237;lico mostrou&#44; em ambos&#44; redu&#231;&#227;o da resist&#234;ncia &#224; quebra&#44; da capta&#231;&#227;o e reten&#231;&#227;o de &#225;gua&#44; e da massa&#46; O cabelo tratado com formalde&#237;do apresentou aumento da irregularidade das cut&#237;culas&#44; potencializado com o uso de calor&#46; O &#225;cido gliox&#237;lico mostrou danos ainda maiores&#46; Essas seriam evid&#234;ncias dos efeitos nocivos dos produtos &#224; haste capilar&#44; a despeito dos achados de aumento da temperatura de desnatura&#231;&#227;o&#44; aus&#234;ncia de aumento de dano oxidativo&#44; e presen&#231;a de brilho observado ap&#243;s os tratamentos&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">14</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Sanad et al&#46; observaram melhor apar&#234;ncia macrosc&#243;pica&#44; correlata ao achado histopatol&#243;gico de diminui&#231;&#227;o de dano cuticular ap&#243;s uso de alisante de queratina contendo metilenoglicol&#44; em cabelos cacheados&#46; Na microscopia eletr&#244;nica&#44; em duas amostras houve aumento da densidade de matriz intermacrofibrilar no c&#243;rtex&#46; Ocorreu tamb&#233;m clareamento do cabelo em alguns indiv&#237;duos&#44; e relato de queda de cabelo em 13&#44;3&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">15</span></a> Em uma avalia&#231;&#227;o de fibras <span class="elsevierStyleItalic">yak</span> e cabelo humano&#44; realizada por Boga et al&#46;&#44; a amostragem tratada com &#225;cido gliox&#237;lico apresentou cut&#237;culas regulares&#59; j&#225; a tratada com solu&#231;&#227;o b&#225;sica e prancha modeladora mostrou mais irregularidades&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">16</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Goshiyama et al&#46;&#44; ao estudarem f&#243;rmulas com glioxiloil&#8208;carbociste&#237;na e glioxiloil&#8208;amino&#225;cidos de queratina&#44; demonstraram maior efeito alisante e mais danos em solu&#231;&#245;es mais &#225;cidas&#46; Alguns dos efeitos colaterais foram altera&#231;&#227;o da for&#231;a&#44; da colora&#231;&#227;o&#44; da entalpia e da quantidade de triptofano das hastes&#46; Na microscopia eletr&#244;nica&#44; notou&#8208;se um filme no cabelo tratado&#44; com sua cut&#237;cula mais selada&#44; parcialmente retirado ap&#243;s cinco lavagens&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">17</span></a> Os resultados est&#227;o dispostos nas <a class="elsevierStyleCrossRefs" href="#tbl0005">tabelas 1 e 2</a>&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">12&#8211;17</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Relaxantes capilares</span><p id="par0075" class="elsevierStylePara elsevierViewall">Os efeitos notados ap&#243;s mais de um alisamento com relaxante qu&#237;mico incluem aumento de <span class="elsevierStyleItalic">frizz</span>&#44; descama&#231;&#227;o do couro cabeludo&#44; perda de cabelo&#44; afinamento ou enfraquecimento do cabelo&#44; discromia dos fios&#44; tricoptilose&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">18</span></a> No Qu&#234;nia&#44; 67&#37; das mulheres com cabelo afro relataram efeitos sist&#234;micos e locais ap&#243;s utiliza&#231;&#227;o de relaxantes capilares de diferentes marcas&#46; Entre as manifesta&#231;&#245;es dermatol&#243;gicas&#44; foram citados&#58; dor e&#47;ou descama&#231;&#227;o no couro cabeludo&#44; rea&#231;&#245;es al&#233;rgicas&#44; atrofia da pele&#44; enfraquecimento e&#47;ou mudan&#231;a da cor do cabelo&#46; Os dois efeitos mais mencionados foram queimaduras e perda de cabelo&#46; A despeito dos efeitos colaterais&#44; 55&#37; optaram por manter algum tipo de alisamento&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">19</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Os impactos de um alisante de marca brasileira&#44; que apresentava dois produtos rotulados como &#8220;livres de qu&#237;mica&#8221; cujos pHs m&#233;dios testados foram de 1&#44;39 e 2&#44;82&#44; abrangeram efeitos graves como quebra ou perda de cabelo em 95&#37;&#44; perda de mais de 40&#37; do cabelo em 56&#37;&#44; aus&#234;ncia de repila&#231;&#227;o em 9&#37;&#44; al&#233;m de outras altera&#231;&#245;es nos fios e do couro cabeludo&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">20</span></a> O pH desses produtos divergiu do padr&#227;o alcalino dos relaxantes&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">20</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Al&#233;m dos efeitos cr&#244;nicos em couro cabeludo&#44; foram relatadas altera&#231;&#245;es agudas secund&#225;rias como em caso de paciente diab&#233;tica que&#44; ap&#243;s uso de hidr&#243;xido de c&#225;lcio&#44; desenvolveu sensa&#231;&#227;o de queima&#231;&#227;o na pele com dermatite de contato e evolu&#231;&#227;o para infec&#231;&#227;o com m&#250;ltiplos abscessos&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">21</span></a> Em pacientes que tiveram sintomas irritativos agudos em couro cabeludo durante processo de relaxamento&#44; ocorreu subsequente desenvolvimento de &#225;reas de alopecia cicatricial&#44; especialmente em v&#233;rtex&#44; com achados histol&#243;gicos sugestivos do diagn&#243;stico de alopecia cicatricial central centr&#237;fuga &#40;ACCC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">22</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Fatores relacionados com ACCC confirmada histologicamente foram investigados por Shah &#38; Alexis&#44; e o uso de alisantes foi o elemento mais comumente relatado nos pacientes com dados dispon&#237;veis&#46; No entanto&#44; em raz&#227;o da aus&#234;ncia de grupo controle&#44; n&#227;o foi poss&#237;vel estabelecer associa&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">23</span></a> Gathers et al&#46; e Olsen et al&#46; n&#227;o encontraram rela&#231;&#227;o dos relaxantes com o desenvolvimento de ACCC&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">24&#44;25</span></a> Entretanto&#44; Olsen et al&#46; encontraram associa&#231;&#227;o estatisticamente significativa entre a idade do primeiro relaxamento e a presen&#231;a de alopecia&#44; quando comparado o padr&#227;o sem alopecia com os padr&#245;es de alopecia mais avan&#231;ada &#40;ACCC prov&#225;vel&#41;&#46; A perda de cabelo n&#227;o impede o uso de relaxantes&#44; embora o diminua conforme sua gravidade aumenta&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">25</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Outros tipos de alopecias tamb&#233;m constituem preocupa&#231;&#227;o&#46; Em meninas afro&#8208;americanas&#44; nas quais a preval&#234;ncia de uso de relaxantes qu&#237;micos foi de 42&#37;&#44; o uso pr&#233;vio de relaxantes dobrou o risco de alopecia de tra&#231;&#227;o&#59; e quando associados a trancinhas rasteiras feitas h&#225; 12 meses&#44; a raz&#227;o de chances ultrapassa cinco&#46; Portanto&#44; h&#225; risco em tracionar cabelo relaxado em penteados apertados&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">26</span></a> Alguns indiv&#237;duos podem ter altera&#231;&#245;es estruturais relacionadas &#224; perda importante de cabelos&#46; Em uma mulher nigeriana at&#243;pica&#44; diagnosticou&#8208;se tricorrexe nodosa generalizada proximal ap&#243;s tr&#234;s epis&#243;dios de queda de cabelo universal&#44; relacionados a procedimentos de relaxamento&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">27</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Estudos t&#234;m explorado a distin&#231;&#227;o na resposta de fios de diferentes etnias ao alisamento&#46; Na avalia&#231;&#227;o de dano cuticular ap&#243;s processo de agita&#231;&#227;o dos fios em &#225;gua&#44; em amostras tratadas com alisante tiol&#44; houve maior suscetibilidade a danos no cabelo tratado&#44; proporcionalmente maior no cabelo chin&#234;s do que no caucasiano&#46; Na microscopia eletr&#244;nica&#44; demonstrou&#8208;se dano cuticular&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">28</span></a> Diversos procedimentos &#40;inclusive alisamentos&#41;&#44; de maneira associada ou n&#227;o&#44; em cabelos naturalmente pretos de diferentes texturas&#44; n&#227;o resultaram em diferen&#231;a vis&#237;vel no exame cl&#237;nico&#44; na dermatoscopia ou na microscopia de luz&#46; J&#225; na microscopia eletr&#244;nica sim&#44; de modo que houve diferen&#231;a significante entre os grupos&#44; com mais danos em quem realiza procedimentos em rela&#231;&#227;o ao grupo controle&#44; mas n&#227;o em rela&#231;&#227;o ao tipo de cabelo ou ao tratamento espec&#237;fico&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">29</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">O comportamento de cabelos caucasianos e cabelo afro no alisamento com tioglicolato divergiu&#46; A demanda de Joules para pentear o cabelo afro diminuiu&#44; mas n&#227;o houve diferen&#231;as dr&#225;sticas nos outros tipos de cabelo&#46; Na avalia&#231;&#227;o da colora&#231;&#227;o&#44; houve maior varia&#231;&#227;o nos cabelos castanho&#8208;escuros e nos afro&#8208;&#233;tnicos&#46; Cabelos virgens de tratamento apresentaram maior for&#231;a t&#234;nsil do que cabelos alisados em todos os tipos de cabelo&#44; e o uso do tioglicolato n&#227;o resultou em perdas adicionais de prote&#237;na ou triptofano&#44; exceto no cabelo afro&#46; Na microscopia eletr&#244;nica&#44; os cabelos castanho&#8208;escuros ondulados&#44; cacheados e afro tiveram discreta abertura das escamas&#44; rachaduras e quebra&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">30</span></a> De maneira oposta&#44; um estudo demonstrou que o cabelo africano foi mais resistente a estresse qu&#237;mico combinado&#46; Quando o alisamento foi combinado &#224; tintura comercial&#44; a cut&#237;cula e o c&#243;rtex africanos foram mais resistentes em rela&#231;&#227;o aos outros grupos &#233;tnicos&#46; Isso n&#227;o era esperado&#44; e talvez a mec&#226;nica pr&#243;pria do cabelo tenha sido alterada&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">31</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">O fio alisado fica mais vulner&#225;vel a outras t&#233;cnicas capilares somadas aos alisantes&#46; Foram encontradas &#225;reas de alopecia permanente onde havia sido aplicado implante capilar artificial do tipo n&#243; italiano ap&#243;s relaxamento&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">32</span></a> Os efeitos da combina&#231;&#227;o entre tintura e alisantes foram estudados em cabelo caucasiano castanho escuro e cacheado&#58; a tintura escolhida pelos pesquisadores e os alisantes aumentam&#44; em rela&#231;&#227;o ao cabelo virgem&#44; a perda de prote&#237;na durante a lavagem&#46; J&#225; quando os dois foram associados&#44; n&#227;o houve aumento adicional significativo nesses valores&#44; exceto para o hidr&#243;xido de s&#243;dio&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">11</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Altera&#231;&#245;es foram demonstradas tamb&#233;m em n&#237;vel molecular&#46; Em amostras de cabelo liso expostas ao hidr&#243;xido de s&#243;dio houve aumento de altera&#231;&#245;es oxidativas&#44; aumento de forma&#231;&#227;o de desidroalanina&#44; desidrata&#231;&#227;o da cadeia lateral e dano &#224; ciste&#237;na&#44; que provavelmente corresponde a dano estrutural&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">33</span></a> A integridade proteica&#44; representada pelo n&#237;vel de triptofano e outros produtos de sua degrada&#231;&#227;o&#44; foi estudada em resposta a danos ap&#243;s alisamento com creme relaxante <span class="elsevierStyleItalic">lye</span>&#46; A fluoresc&#234;ncia para triptofano diminuiu&#44; mas n&#227;o houve diferen&#231;a nas quinureninas &#40;um dos metab&#243;litos do triptofano&#41;&#44; o que pode significar ocorr&#234;ncia de degrada&#231;&#227;o tanto do triptofano quanto de seus metab&#243;litos pelo processo qu&#237;mico&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">34</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Cabelos brancos afro e caucasiano foram submetidos a alisamento com tioglicolato de am&#244;nia ou tratamento triplo com o mesmo alisante associado &#224; descolora&#231;&#227;o com am&#244;nia e per&#243;xido de hidrog&#234;nio e tamb&#233;m &#224; prancha alisante&#46; Ap&#243;s os tratamentos&#44; liga&#231;&#245;es importantes foram alteradas&#44; com pequenas diferen&#231;as entre as etnias&#46; O alisamento teve maior a&#231;&#227;o na banda pertencente ao &#225;cido cisteico e acarretou em les&#245;es na fibra&#44; com irregularidades e destacamento cuticular&#44; e pequenas ondula&#231;&#245;es em sua extens&#227;o&#46; O tratamento triplo demonstrou hastes com contornos irregulares&#44; destacamento e deforma&#231;&#227;o cuticular&#44; e tamb&#233;m poss&#237;vel dano cortical&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">35</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Ao comparar um produto A &#40;<span class="elsevierStyleItalic">lye</span>&#41; com um produto B &#40;<span class="elsevierStyleItalic">no&#8208;lye</span>&#44; com hidr&#243;xido de guanidina&#41;&#44; Mamabolo et al&#46; evidenciaram&#44; na haste&#44; diminui&#231;&#227;o de cistina ap&#243;s o tratamento com os dois produtos&#44; com maior perda com o uso do produto B&#46; A redu&#231;&#227;o da cistina foi acompanhada de maior atividade alisante&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">36</span></a> N&#227;o houve diferen&#231;a significativa na tolerabilidade dos dois produtos no couro cabeludo&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">36</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Khumalo et al&#46; encontraram diferen&#231;a na quantidade de quatro amino&#225;cidos entre os grupos com alisamento e o grupo sem&#58; cistina&#44; citrulina&#44; arginina e glutamina&#46; Os n&#237;veis de cistina no cabelo tratado foram similares aos encontrados em tricotiodistrofia&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">37</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Com foco nas altera&#231;&#245;es inflamat&#243;rias&#44; Beach et al&#46; coletaram algumas citocinas no sebo do couro cabeludo de mulheres que realizaram procedimentos com subst&#226;ncias relaxantes ou permaneceram com cabelos naturais&#46; Em n&#237;veis suficientes para interpreta&#231;&#227;o&#44; foram detectadas a IL&#8208;1&#945; &#40;pr&#243;&#8208;inflamat&#243;ria&#41; e a IL&#8208;1ra &#40;antiinflamat&#243;ria&#41;&#44; e embora diferen&#231;as das citocinas entre o v&#233;rtex e a coroa possam refletir predisposi&#231;&#227;o distinta dos locais do couro cabeludo &#224; inflama&#231;&#227;o&#44; n&#227;o se conseguiu demonstrar mudan&#231;as nas citocinas inflamat&#243;rias espec&#237;ficas ap&#243;s uso de relaxantes&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">38</span></a> Tackey et al&#46;&#44; utilizando um modelo de epiderme tridimensional&#44; compararam alisantes <span class="elsevierStyleItalic">lye</span> e <span class="elsevierStyleItalic">no&#8208;lye</span> pareados com controles n&#227;o tratados&#44; em rela&#231;&#227;o a citocinas envolvidas na modula&#231;&#227;o de irrita&#231;&#227;o ap&#243;s alisamento&#46; A IL&#8208;1&#945; atingiu n&#237;veis maiores em 24 e 48 horas ap&#243;s o uso de alisante <span class="elsevierStyleItalic">no&#8208;lye</span>&#46; Ambos os alisantes resultaram em n&#237;veis de prostaglandina E2 &#40;PGE2&#41; maiores do que os controles em todos os per&#237;odos avaliados&#44; e a citocina poderia ter responsabilidade sobre as diferen&#231;as sensoriais entre os diversos tipos de produtos&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">39</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Agentes condicionantes e protetores podem minimizar os danos causados pelos alisantes&#44; e sua interfer&#234;ncia na efic&#225;cia do alisamento &#233; controversa&#46;<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">40&#8211;42</span></a> Os achados encontram&#8208;se sintetizados nas <a class="elsevierStyleCrossRefs" href="#tbl0015">tabelas 3 a 7</a>&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">11&#44;18&#8211;43</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Alisantes em geral</span><p id="par0145" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; exposi&#231;&#227;o a alisantes&#44; Marks et al&#46; compararam pacientes com alopecia cicatricial e pacientes com alopecia n&#227;o cicatricial &#40;grupo controle&#41;&#46; Houve diferen&#231;a significativa nos grupos sobre a hist&#243;ria pr&#233;via de alisamento qu&#237;mico &#40;25&#37; no grupo com alopecia cicatricial e 13&#37; no grupo n&#227;o cicatricial&#41;&#44; decorrente especialmente do papel dos pacientes com l&#237;quen plano pilar e AFF&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">43</span></a> Esse estudo n&#227;o especifica quais alisantes foram utilizados pelos indiv&#237;duos&#44; mas cita como exemplos hidr&#243;xido de s&#243;dio e glutaralde&#237;do&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">43</span></a> O resumo dos resultados encontra&#8208;se na <a class="elsevierStyleCrossRef" href="#tbl0040">tabela 8</a>&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">43</span></a></p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Discuss&#227;o</span><p id="par0150" class="elsevierStylePara elsevierViewall">Os alisantes baseados em formalde&#237;do ou derivados s&#227;o&#44; em geral&#44; compostos por alde&#237;do e prote&#237;nas como a queratina hidrolisada&#58; ap&#243;s exposi&#231;&#227;o ao calor&#44; o alde&#237;do promoveria <span class="elsevierStyleItalic">cross&#8208;link</span> entre as queratinas do produto e as do cabelo&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">9</span></a> Supostamente&#44; o alisamento se d&#225; pela difus&#227;o da queratina para o c&#243;rtex preenchendo os defeitos e reestruturando o fio&#59; no entanto&#44; n&#227;o h&#225; evid&#234;ncias desse efeito&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">9</span></a> O uso de formalde&#237;do e glutaralde&#237;do como alisantes n&#227;o &#233; permitido no Brasil&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">7</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Os produtos com &#225;cido gliox&#237;lico s&#227;o citados no site da Anvisa como glioxiloil&#8208;carbociste&#237;na e glioxiloil&#8208;amino&#225;cidos de queratina na sess&#227;o &#8220;orienta&#231;&#245;es sobre os alisantes &#8211; o que devo encontrar no r&#243;tulo desses produtos&#8221;&#44; com a ressalva de que devem alertar o consumidor sobre o risco de queda ou de altera&#231;&#227;o de cor dos cabelos&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">7</span></a> Por&#233;m&#44; a subst&#226;ncia n&#227;o consta na IN n&#176; 64 do &#243;rg&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">10</span></a> A carbociste&#237;na n&#227;o &#233; um alisante quando utilizada isoladamente&#44; mas geralmente &#233; formulada com o &#225;cido gliox&#237;lico&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">8</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Os alisantes &#225;cidos continuam sendo uma constante em produtos de alisamento&#46; Localmente&#44; o formalde&#237;do pode causar dermatite&#44; inclusive eczema al&#233;rgico e eczema psoriasiforme&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">12&#44;13</span></a> O relato na literatura m&#233;dica das rea&#231;&#245;es em couro cabeludo pode ser subestimado&#44; pois a dermatite de contato irritativa ap&#243;s o uso do formalde&#237;do &#233; frequentemente considerada um efeito normal pelos usu&#225;rios&#46; Na haste capilar&#44; o formalde&#237;do e o &#225;cido gliox&#237;lico&#44; a despeito do brilho no aspecto macrosc&#243;pico&#44; pioraram a irregularidade das cut&#237;culas &#224; microscopia eletr&#244;nica e diminu&#237;ram a resist&#234;ncia &#224; quebra&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">14</span></a> No entanto&#44; outros estudos n&#227;o demonstraram o mesmo dano&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">15&#44;16</span></a> Embora haja altera&#231;&#245;es na for&#231;a&#44; na colora&#231;&#227;o do cabelo e outras evid&#234;ncias de dano &#224; haste&#44; o trabalho para pentear diminui com os alisantes &#225;cidos&#44; como demonstrado em estudo com &#225;cido gliox&#237;lico&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">17</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">J&#225; os alisantes permitidos por lei no Brasil s&#227;o os previstos na IN n&#176; 64<span class="elsevierStyleHsp" style=""></span>da ANVISA&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">10</span></a> Os hidr&#243;xidos agem em raz&#227;o de seu alto pH&#44; abrindo as cut&#237;culas e propiciando a a&#231;&#227;o do agente alcalino redutor no c&#243;rtex&#44; onde as liga&#231;&#245;es dissulfeto s&#227;o quebradas&#46; O cabelo &#233; ent&#227;o mecanicamente alisado&#44; com reestrutura&#231;&#227;o das liga&#231;&#245;es entre as queratinas&#46; Em seguida&#44; o cabelo &#233; exposto &#224; subst&#226;ncia &#225;cida para encerrar o processo e fechar as cut&#237;culas &#40;processo de neutraliza&#231;&#227;o&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">1&#44;8&#44;44</span></a> Os &#225;lcalis reagem com a cistina e produzem a lantionina&#44; na chamada lantioniza&#231;&#227;o&#46; Esse processo substitui um ter&#231;o da cistina por lantionina&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">8</span></a> N&#227;o existe necessidade de calor ou tra&#231;&#227;o externa&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">8</span></a> Diferentemente&#44; o tioglicolato n&#227;o age por lantioniza&#231;&#227;o&#44; mas por redu&#231;&#227;o seletiva das liga&#231;&#245;es de cistina sem alterar a prote&#237;na inteira&#44; &#233; neutralizado com per&#243;xido de hidrog&#234;nio ou bromato de s&#243;dio e as liga&#231;&#245;es s&#227;o rearranjadas&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">8&#44;44</span></a> O calor deve ser aplicado para o passo de tratamento t&#233;rmico&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">8&#44;44</span></a> Seu uso &#233; comumente chamado de &#8220;escova japonesa&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">8</span></a> Mant&#234;m&#8208;se 90&#37; do conte&#250;do de cistina e 10&#37; tornam&#8208;se &#225;cido cisteico&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">8</span></a> Existe ainda o bissulfito de am&#244;nia&#44; menos agressivo&#44; menos efetivo e mais empregado em produtos de uso domiciliar&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">3</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Os alisantes do tipo relaxantes n&#227;o s&#227;o isentos de efeitos colaterais&#46; T&#234;m sido citados alergias&#44; <span class="elsevierStyleItalic">frizz</span> na haste&#44; cabelos secos&#44; afinamento e enfraquecimento do fio&#44; tricoptilose e altera&#231;&#227;o de colora&#231;&#227;o dos cabelos&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">18&#8211;20&#44;30</span></a> No couro cabeludo&#44; s&#227;o descritos descama&#231;&#227;o&#44; dor&#44; atrofia&#44; at&#233; queimaduras e quadros potencialmente graves de eczema de contato com infec&#231;&#227;o secund&#225;ria&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">18&#8211;21</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">As consequ&#234;ncias da inflama&#231;&#227;o aguda a longo prazo n&#227;o s&#227;o conhecidas&#44; mas aventa&#8208;se at&#233; rela&#231;&#227;o com alopecia cicatricial central centr&#237;fuga&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">22</span></a> Uma hip&#243;tese seria que altera&#231;&#245;es de citocinas causadas por alisantes possam exercer algum papel no processo inflamat&#243;rio&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">38</span></a> A rela&#231;&#227;o das citocinas&#44; inclusive com as diferen&#231;as sensoriais entre os tipos de produtos&#44; tem sido estudada&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">39</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">A perda de cabelo tamb&#233;m tem sido relacionada&#44; inclusive com alopecia irrevers&#237;vel&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">18&#8211;20</span></a> Os dados referentes &#224; associa&#231;&#227;o com ACCC divergem&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">23&#8211;25&#44;43</span></a> Existe aumento do risco de alopecia de tra&#231;&#227;o com relaxantes&#44; especialmente se associados a tran&#231;as rasteiras&#44; e tricorrexe nodosa generalizada proximal foi relacionada a alisamentos&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Na haste&#44; com o uso dos relaxantes&#44; h&#225; ocorr&#234;ncia de aumento da dist&#226;ncia inter&#8208;escamas&#44; abertura das escamas&#44; irregularidade de suas bordas&#44; rachaduras&#44; grave levantamento da cut&#237;cula com exposi&#231;&#227;o do c&#243;rtex&#44; les&#245;es na fibra&#44; aumento das part&#237;culas extra&#237;das do fio&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">28&#8211;30&#44;35</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">O uso de alisantes concomitantemente a outras t&#233;cnicas capilares parece aumentar a vulnerabilidade a danos&#46; Relaxamentos capilares somados ao uso de implante capilar artificial relacionaram&#8208;se com &#225;reas de alopecia permanente&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">32</span></a> Relaxantes resultaram em maior propens&#227;o &#224; perda proteica&#44; e&#44; quando associado &#224; tintura&#44; o hidr&#243;xido de s&#243;dio mostrou&#8208;se ainda mais agressivo&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">11</span></a> A somat&#243;ria de alisamento com tioglicolato de am&#244;nia&#44; descolora&#231;&#227;o e prancha alisante resultou em hastes com contornos irregulares&#44; destacamento e deforma&#231;&#227;o cuticular e poss&#237;vel dano cortical&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">35</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Com alisantes <span class="elsevierStyleItalic">lye</span> e <span class="elsevierStyleItalic">no&#8208;lye</span> foi encontrada diferen&#231;a na quantidade de amino&#225;cidos em rela&#231;&#227;o ao cabelo virgem&#46; &#201; not&#243;ria a diminui&#231;&#227;o de cistina&#44; presente nas liga&#231;&#245;es dissulfeto que d&#227;o for&#231;a ao cabelo&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">37</span></a> A n&#237;vel molecular&#44; em cabelo liso europeu exposto a hidr&#243;xido de s&#243;dio houve deteriora&#231;&#227;o da ciste&#237;na&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">33</span></a> Alisamento com relaxante <span class="elsevierStyleItalic">lye</span> degradou triptofano&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">34</span></a> Entretanto&#44; o uso do tioglicolato n&#227;o resultou em perdas adicionais de prote&#237;na ou triptofano&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">30</span></a> Comparando alisante <span class="elsevierStyleItalic">lye</span> e <span class="elsevierStyleItalic">no&#8208;lye</span> houve redu&#231;&#227;o de cistina ap&#243;s ambos&#44; com maior perda com <span class="elsevierStyleItalic">no&#8208;lye</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">36</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Cabelos de etnias diferentes parecem divergir na suscetibilidade ao alisamento&#44; com achados variados na literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">31&#44;35</span></a> Os danos estruturais podem ser minimizados por agentes condicionantes&#44; algumas ceramidas e ceras&#46;<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">40&#8211;42</span></a> Apesar dos efeitos colaterais&#44; muitas mulheres optam por manter os alisamentos&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">19&#44;25</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">As limita&#231;&#245;es do estudo foram&#58; busca restrita a apenas tr&#234;s bases de dados&#59; busca em apenas dois idiomas&#59; escassez de pesquisas resultando em baixo rigor cient&#237;fico para inclus&#227;o de artigos&#59; aceite de diversos desenhos de estudo&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclus&#227;o</span><p id="par0210" class="elsevierStylePara elsevierViewall">A revis&#227;o de dados referentes aos &#250;ltimos 20 anos&#44; mesmo com limita&#231;&#245;es&#44; retrata a ocorr&#234;ncia expressiva de altera&#231;&#245;es em haste capilar e couro cabeludo secund&#225;rias aos alisamentos capilares&#46; Inflama&#231;&#227;o cl&#237;nica e subcl&#237;nica do couro cabeludo&#44; danos &#224; haste&#44; perda de cabelo por fratura do fio ficaram evidentes&#46; Os efeitos a longo prazo ainda permanecem desconhecidos&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Os profissionais de sa&#250;de&#44; especialmente o m&#233;dico dermatologista&#44; assim como os profissionais de sal&#245;es de beleza e seus clientes precisam conhecer os riscos e benef&#237;cios desses tratamentos qu&#237;micos&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">A recente norma da Anvisa limita o registro de alisantes&#44; mas n&#227;o esclarece quanto aos novos &#8220;alisantes &#225;cidos&#8221;&#44; como o &#225;cido gliox&#237;lico&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">10</span></a> Os efeitos dos alisantes &#225;cidos est&#227;o em voga especialmente por conta do estudo multic&#234;ntrico brasileiro que levantou a hip&#243;tese da associa&#231;&#227;o da alopecia frontal fibrosante com procedimentos de alisamento com formol&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">45</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Estudos com rigor cient&#237;fico s&#227;o necess&#225;rios para compreender melhor as respostas das estruturas capilares aos agentes qu&#237;micos&#44; em especial sua rela&#231;&#227;o com o desenvolvimento de alopecias&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Esta pesquisa n&#227;o recebeu nenhum financiamento espec&#237;fico de ag&#234;ncias de fomento p&#250;blicas&#44; privadas ou sem fins lucrativos&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Suporte financeiro</span><p id="par0235" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Contribui&#231;&#227;o dos autores</span><p id="par0240" class="elsevierStylePara elsevierViewall">Joane Nathache Hatsbach de Paula&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Fl&#225;via Machado Alves Bas&#237;lio&#58; Concep&#231;&#227;o e planejamento do estudo&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Fabiane Andrade Mulinari&#8208;Brenner&#58; Participa&#231;&#227;o efetiva da orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflito de interesses</span><p id="par0255" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1 &#40;F&#58;1&#44; M&#58;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="6" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \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">Fibras <span class="elsevierStyleItalic">yak</span> e cabelo humano&nbsp;\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">&#193;cido Gliox&#237;lico&nbsp;\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">Persist&#234;ncia da regularidade cuticular &#224; microscopia eletr&#244;nica&nbsp;\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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Goshiyama et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">17</span></a> 2020</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amostras de cabelo cacheado castanho escuro</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">glioxiloil&#8208;carbociste&#237;na e glioxiloil&#8208;amino&#225;cidos de queratina</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">Redu&#231;&#227;o do trabalho para pentear de&#58; 59&#44;4&#37; &#40;pH 1&#44;0&#41;&#44; 33&#44;3&#37; &#40;pH 2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Redu&#231;&#227;o da for&#231;a da haste em&#58; 15&#44;7&#37; &#40;pH 1&#44;0&#41;&#44; 8&#44;7&#37; &#40;pH 2&#44;0&#41;&#46; Sem signific&#226;ncia estat&#237;stica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambos os pHs&#58; altera&#231;&#227;o de colora&#231;&#227;o&#44; redu&#231;&#227;o na entalpia das hastes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudos sobre os efeitos dos alisantes &#225;cidos na haste do cabelo</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">n<span class="elsevierStyleItalic">&#44;</span> n&#250;mero de pacientes&#59; F&#44; feminino&#59; M&#44; masculino&#46;</p>"
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              "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"><th 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" scope="col" style="border-bottom: 2px solid black">Autor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Tipo de estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Agente alisante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#245;es em haste e em couro cabeludo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shetty et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">18</span></a> 2013</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transversal &#40;question&#225;rio&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>90 &#40;F&#58;90&#44; M&#58;0&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relaxantes qu&#237;micos</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">Aumento do <span class="elsevierStyleItalic">frizz</span> &#40;67&#37; dos casos&#41;&#44; afinamento ou enfraquecimento do cabelo &#40;40&#37;&#41;&#44; discromia &#40;acinzentamento&#41; do cabelo &#40;22&#37;&#41;&#44; tricoptilose &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Descama&#231;&#227;o do couro cabeludo &#40;61&#37;&#41; e perda de cabelo &#40;47&#37;&#41;&nbsp;\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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Etemesi BA&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">19</span></a> 2007</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transversal &#40;question&#225;rio&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">242 &#40;F&#58;242&#44; M&#58;0&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relaxantes qu&#237;micos</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">Enfraquecimento e&#47;ou mudan&#231;a da cor do cabelo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor e&#47;ou descama&#231;&#227;o no couro cabeludo&#44; rea&#231;&#245;es al&#233;rgicas&#44; afinamento da pele&#44; queimaduras e perda de cabelo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kaur et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">21</span></a> 2002&nbsp;\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">Relato de caso&nbsp;\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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1 &#40;F&#58;1&#41;&nbsp;\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">Hidr&#243;xido de c&#225;lcio&nbsp;\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">Eczema de contato e infec&#231;&#227;o estafiloc&#243;cica secund&#225;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">n&#44; n&#250;mero de pacientes&#59; F&#44; feminino&#59; M&#44; masculino&#46;</p>"
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            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"><th 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" scope="col" style="border-bottom: 2px solid black">Autor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Tipo de estudo&nbsp;\t\t\t\t\t\t\n
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                  \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" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Agente alisante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#245;es em haste e em couro cabeludo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Swee et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">20</span></a> 2000</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transversal &#40;question&#225;rio&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>464 &#40;F&#58;457&#44; M&#58;5&#44; n&#227;o identificado&#58; 2&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relaxante &#225;cido &#40;n&#227;o tradicional&#41; com sais met&#225;licos</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">Quebra ou perda de cabelo &#40;95&#37; dos casos&#41;&#44; cabelos secos ou &#225;speros &#40;70&#37;&#41;&#44; descolora&#231;&#227;o do cabelo &#40;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Couro cabeludo seco &#40;53&#37;&#41;&#44; dor em queima&#231;&#227;o em couro cabeludo &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th 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" scope="col" style="border-bottom: 2px solid black">Autor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tipo de estudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Alisante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#245;es em couro cabeludo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Khumalo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">22</span></a> 2007</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#233;rie de casos</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5 &#40;M&#58;5&#44; H&#58;0&#41;</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">Hidr&#243;xido de s&#243;dio &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\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">Sintomas irritativos e desenvolvimento de &#225;reas de alopecia cicatricial&#46; Achados histol&#243;gicos de infiltrado linfoc&#237;tico perifolicular&#44; fibrose folicular e descama&#231;&#227;o prematura da bainha radicular interna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidr&#243;xido de guanidina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shah &#38; Alexis&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">23</span></a> 2010&nbsp;\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">S&#233;rie de casos&nbsp;\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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>69 &#40;M&#58;67&#44; H&#58;2&#41; &#40;64&#58; dados sobre cuidados com cabelos&#41;&nbsp;\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">Relaxantes qu&#237;micos&nbsp;\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">Alisantes foram a pr&#225;tica traum&#225;tica mais comum em pacientes com ACCC&#46; N&#227;o foi poss&#237;vel estabelecer associa&#231;&#227;o devido &#224; aus&#234;ncia de grupo controle&nbsp;\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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gathers et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">24</span></a> 2009</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caso&#8208;controle</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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>101 &#40;M&#58;101&#44; H&#58;0&#41;&nbsp;\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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relaxantes qu&#237;micos</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sem rela&#231;&#227;o de uso de relaxantes&#44; de sua frequ&#234;ncia de aplica&#231;&#227;o ou de complica&#231;&#245;es de seu uso com o desenvolvimento de ACCC</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo ACCC &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo sem alopecia cicatricial &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;&nbsp;\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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Olsen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">25</span></a> 2011</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caso&#8208;controle</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>529 &#40;M&#58;529&#44; H&#58;0&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relaxantes qu&#237;micos</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">Sem associa&#231;&#227;o do uso de relaxantes ou de rea&#231;&#227;o a eles com queda extensa central de cabelo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Associa&#231;&#227;o entre a idade do primeiro relaxamento e o padr&#227;o de perda quando comparado o padr&#227;o 0 &#40;sem perda&#41; <span class="elsevierStyleItalic">vs</span>&#46; os padr&#245;es 3 e 5 &#40;ACCC prov&#225;vel&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rucker et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">26</span></a> 2011&#46;&nbsp;\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">Transversal &#40;question&#225;rio&#41;&nbsp;\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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>201 &#40;M&#58;201&#44; H&#58;0&#41;&nbsp;\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">Relaxantes qu&#237;micos&nbsp;\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">Relaxamento foi fator de risco para alopecia de tra&#231;&#227;o &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;2&#59; &#40;95&#37; CI 1&#44;1&#8211;4&#44;5&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;No relaxamento associado a trancinhas rasteiras&#58; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44;27 &#40;95&#37; CI 1&#44;5&#8211;18&#44;32&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ogunbiyi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">27</span></a> 2014&nbsp;\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">Relato de caso&nbsp;\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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1 &#40;F&#58;1&#41;&nbsp;\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">Relaxantes qu&#237;micos&nbsp;\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">Perda de cabelos relacionada &#224; tricorrexe nodosa generalizada proximal&#44; com atopia como condi&#231;&#227;o basal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amorim et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">32</span></a> 2017&nbsp;\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">Transversal&nbsp;\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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30 &#40;F&#58;30&#44; M&#58;0&#41;&nbsp;\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">Hidr&#243;xido de s&#243;dio ou hidr&#243;xido de guanidina&nbsp;\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">Quando associados a implante capilar artificial do tipo n&#243; italiano&#44; relacionaram&#8208;se com &#225;reas de alopecia permanente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Estudos que avaliaram a associa&#231;&#227;o de relaxantes capilares &#224; alopecia</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">n&#44; n&#250;mero de pacientes&#59; F&#44; feminino&#59; M&#44; masculino&#46;</p>"
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            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"><th 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" scope="col" style="border-bottom: 2px solid black">Autor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Tipo de estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Alisante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#245;es em haste e couro cabeludo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Galliano et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">28</span></a> 2010</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12 &#40;6 amostras de cabelo chinesas e 6 amostras de cabelo caucasianas&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alisante tiol</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">Aumento da dist&#226;ncia inter&#8208;escamas&#44; da inclina&#231;&#227;o das escamas e da irregularidade de suas bordas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#233;dia de tamanho das part&#237;culas extra&#237;das do cabelo ap&#243;s agita&#231;&#227;o em &#225;gua por 30 minutos&#58; diferente entre as etnias e aumento proporcionalmente maior no cabelo chin&#234;s&nbsp;\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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kaliyadan et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">29</span></a> 2016</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transversal</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25 &#40;F&#58;25&#41; &#40;19 sujeitos e 6 controles&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relaxantes qu&#237;micos</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 alisamento isolado &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#58; o cabelo cacheado teve dano grau 2 &#40;grave levantamento da cut&#237;cula&#44; rachaduras ou buracos com exposi&#231;&#227;o do c&#243;rtex&#41; e o cabelo ondulado grau 0 &#40;cut&#237;cula intacta&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No alisamento associado a colora&#231;&#227;o &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&#58; graus de dano de 1 &#40;cut&#237;cula irregular sem rachaduras ou buracos&#41; a 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Na associa&#231;&#227;o de alisamento&#44; descolora&#231;&#227;o e colora&#231;&#227;o &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#58; dano grau 3 &#40;c&#243;rtex parcialmente exposto&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No grupo controle &#40;cabelo ondulado ou liso&#41;&#58; grau de dano de 0 a 1&nbsp;\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  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bloch et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">30</span></a> 2019</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amostras de cabelo caucasiano &#40;liso castanho escuro&#59; liso loiro&#59; ondulado castanho escuro&#59; e cacheado castanho escuro&#41; e cabelo afro</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tioglicolato de am&#244;nia</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">Redu&#231;&#227;o de 71&#37; no trabalho &#40;em Joules&#41; para pentear os cabelos afro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maior varia&#231;&#227;o de colora&#231;&#227;o nos cabelos castanho escuros e nos afro&#8208;&#233;tnicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diminui&#231;&#227;o de for&#231;a t&#234;nsil em todos os tipos de cabelo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sem perdas adicionais de prote&#237;na ou triptofano &#40;exceto no cabelo afro&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabelos castanho escuros ondulados&#44; cacheados e afro&#58; discreta abertura das escamas&#44; rachaduras e quebra&nbsp;\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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lee et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">31</span></a> 2014</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amostras de cabelo asi&#225;tico&#44; caucasiano europeu e afro&#8208;americano</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tioglicolato de am&#244;nia</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 alisamento&#58; as cut&#237;culas dos cabelos asi&#225;ticos foram as mais resistentes&#46; O dano ao c&#243;rtex foi similar nos tr&#234;s grupos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No alisamento combinado &#224; tintura comercial&#58; a cut&#237;cula e c&#243;rtex africanos foram as mais resistentes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Os tr&#234;s grupos apresentaram padr&#245;es semelhantes de dano &#224; membrana celular ap&#243;s o alisamento ou alisamento combinado com tintura&nbsp;\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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fran&#231;a&#8208;Stefoni et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">11</span></a> 2015</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabelo caucasiano castanho escuro e cacheado</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tioglicolato de am&#244;nia&#44; hidr&#243;xido de guanidina&#44; hidr&#243;xido de s&#243;dio</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">Perda proteica adicional na lavagem&#58; tintura &#40;48&#37;&#41;&#44; tioglicolato de am&#244;nia &#40;159&#37;&#41;&#59; hidr&#243;xido de guanidina &#40;188&#37;&#41;&#59; hidr&#243;xido de s&#243;dio &#40;276&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quando associados &#224; tintura&#44; o tioglicolato de am&#244;nia e hidr&#243;xido de guanidina n&#227;o causaram aumento adicional significante na perda proteica&#46; O hidr&#243;xido de s&#243;dio sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dyer et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">33</span></a> 2013&nbsp;\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">Ensaio cl&#237;nico&nbsp;\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">Amostras de cabelo liso europeu&nbsp;\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">Hidr&#243;xido de s&#243;dio&nbsp;\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">Aumento de altera&#231;&#245;es oxidativas&#44; danos associados a &#225;lcali&#44; aumento de forma&#231;&#227;o de desidroalanina e desidrata&#231;&#227;o da cadeia lateral&#44; e dano &#224; ciste&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">McMullen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">34</span></a> 2011&nbsp;\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">Ensaio cl&#237;nico&nbsp;\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">Amostras de cabelos europeus castanhos escuros e cabelos <span class="elsevierStyleItalic">Piedmont</span>&nbsp;\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">Hidr&#243;xido de s&#243;dio&nbsp;\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">Degrada&#231;&#227;o de triptofano e seus metab&#243;litos&nbsp;\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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dos Santos et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">35</span></a> 2019</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amostras de cabelos brancos afro e caucasiano</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tioglicolato de am&#244;nia</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">Les&#245;es na fibra&#44; com irregularidades e destacamento cuticular&#44; e pequenas ondula&#231;&#245;es em sua extens&#227;o&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Associa&#231;&#227;o de alisamento com descolora&#231;&#227;o e prancha alisante&#58; hastes com contornos irregulares&#44; destacamento e deforma&#231;&#227;o cuticular&#44; e poss&#237;vel dano cortical&#46;&nbsp;\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  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mamabolo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">36</span></a> 2013</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#58; 5 &#40;F&#58;5&#44; M&#58;0&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidr&#243;xido de s&#243;dio e Hidr&#243;xido de Guanidina</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">Hidr&#243;xido de guanidina&#58; maior maciez&#44; aspecto liso&#44; brilho&#44; e menos aspecto seco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Os dois produtos foram similares quanto ao dano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O alisante <span class="elsevierStyleItalic">no&#8208;lye</span> obteve menos pontas duplas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O conte&#250;do de cistina reduzido com o alisante <span class="elsevierStyleItalic">lye</span> e de forma mais intensa com o alisante <span class="elsevierStyleItalic">no&#8208;lye</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A lisina diminuiu em rela&#231;&#227;o ao cabelo virgem para os dois alisantes&#44; no entanto sem diferen&#231;a estat&#237;stica entre eles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Khumalo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">37</span></a> 2010&nbsp;\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">Coorte hist&#243;rica&nbsp;\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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&nbsp;\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">Relaxantes qu&#237;micos&nbsp;\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">A cistina&#44; a citrulina &#40;nem sempre com signific&#226;ncia estat&#237;stica&#41; e a arginina diminu&#237;ram e a glutamina aumentou nos cabelos relaxados&#46; Os n&#237;veis de cistina foram menores no cabelo tratado do que no cabelo virgem&#44; com n&#237;veis similares aos encontrados em tricotiodistrofia&nbsp;\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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Beach et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">38</span></a> 2012&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36 &#40;F&#58;30&#44; M&#58;0&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidr&#243;xido de guanidina&#44; hidr&#243;xido de s&#243;dio&#44; tioglicolato de am&#244;nia</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">IL&#8208;1&#945; e IL&#8208;1ra foram detectadas no couro cabeludo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ap&#243;s o alisamento&#44; os n&#237;veis de IL&#8208;1&#945; e IL&#8208;1ra na coroa e v&#233;rtex foram menores&#44; mas sem diferen&#231;a em rela&#231;&#227;o ao grupo que n&#227;o aliso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o se conseguiu demonstrar mudan&#231;as nas citocinas inflamat&#243;rias espec&#237;ficas ap&#243;s uso de relaxantes&nbsp;\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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tackey et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">39</span></a> 2013</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Modelo de epiderme tridimensional</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidr&#243;xido de s&#243;dio&#44; hidr&#243;xido de guanidina</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">IL&#8208;1&#945;&#58; em 4h da aplica&#231;&#227;o n&#227;o mostrou diferen&#231;a significativa entre os grupos de alisantes&#44; e em 24h e 48h o alisante <span class="elsevierStyleItalic">no&#8208;lye</span> atingiu n&#237;veis maiores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL&#8208;1ra&#58; sempre maior com o <span class="elsevierStyleItalic">no&#8208;lye</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Os dois tipos tiveram raz&#245;es de IL&#8208;1ra&#47;IL&#8208;1&#945; similares nas fases iniciais &#40;sugere aus&#234;ncia de rela&#231;&#227;o com o desconforto imediato ap&#243;s a aplica&#231;&#227;o&#41; e tardias&#44; no entanto os <span class="elsevierStyleItalic">no&#8208;lye</span> tiveram uma raz&#227;o maior em 24h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#237;veis de PGE2 maiores do que os controles em todos os per&#237;odos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2878234.png"
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Estudos sobre relaxantes capilares com avalia&#231;&#245;es morfol&#243;gicas e fisiol&#243;gicas</p>"
        ]
      ]
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        "etiqueta" => "Tabela 7"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
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            "identificador" => "at7"
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        "tabla" => array:1 [
          "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"><th 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" scope="col" style="border-bottom: 2px solid black">Autor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Formato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Alisante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Efeitos em haste&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">De S&#225; Dias et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">40</span></a> 2008</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amostras de cabelo afro</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tioglicolato de am&#244;nia</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">Agentes condicionantes adicionados ao alisante resultaram em menor perda proteica&#44; em prote&#231;&#227;o da fibra e em aumento da resist&#234;ncia &#224; quebra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Podem reduzir a efic&#225;cia do alisamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bernard et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">41</span></a> 2002&nbsp;\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">Ensaio cl&#237;nico&nbsp;\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">Amostras de cabelo afro&#8208;americano&nbsp;\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">Hidr&#243;xido de guanidina ou hidr&#243;xido de s&#243;dio&nbsp;\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">Uso de ceramidas &#40;no caso&#44; a C18&#8208;dhCer&#41; preveniu danos em cabelo alisado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vermeulen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">42</span></a> 2004&nbsp;\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">Ensaio cl&#237;nico&nbsp;\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">Amostras de cabelo&nbsp;\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">Hidr&#243;xido de s&#243;dio&#44; hidr&#243;xido de l&#237;tio&nbsp;\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">Adi&#231;&#227;o de ceras de polimetileno em f&#243;rmula alisante resultou em melhor aspecto em compara&#231;&#227;o a f&#243;rmulas comerciais&#44; sem minimizar a performance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Estudos sobre preven&#231;&#227;o de danos estruturais no uso de relaxantes capilares</p>"
        ]
      ]
      8 => array:8 [
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        "etiqueta" => "Tabela 8"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at8"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">n&#44; n&#250;mero de pacientes&#59; F&#44; feminino&#59; M&#44; masculino&#46;</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"><th 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" scope="col" style="border-bottom: 2px solid black">Autor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Tipo de estudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Agente alisante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Marks et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">43</span></a> 2019</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caso&#8208;controle</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>286 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43 pacientes com alopecia cicatricial&#41;&#44; &#40;143 pacientes com alopecia n&#227;o cicatricial&#58; grupo controle&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alisamento qu&#237;mico</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">Maior frequ&#234;ncia de alisamento no grupo alopecia cicatricial &#40;25&#37;&#41; em rela&#231;&#227;o ao grupo controle &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hist&#243;ria pr&#233;via de alisamento em LPP&#47;AFF de 21&#37; e em 10&#37; dos controles pareados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ACCC&#58; mais exposi&#231;&#227;o cumulativa a alisantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2878230.png"
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Estudos sobre os efeitos dos alisantes &#225;cidos e alisantes tradicionais &#40;relaxantes capilares&#41;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:45 [
            0 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hair care products&#58; waving&#44; straightening&#44; conditioning&#44; and coloring"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Bolduc"
                            1 => "J&#46; Shapiro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0738-081x(01)00201-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Dermatol&#46;"
                        "fecha" => "2001"
                        "volumen" => "19"
                        "paginaInicial" => "431"
                        "paginaFinal" => "436"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11535384"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hair and Scalp Diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;J&#46; McMichael"
                            1 => "M&#46;K&#46; Hordinsky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2008"
                        "editorial" => "Informa Healthcare"
                        "editorialLocalizacion" => "New York"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hair Care&#58; An Illustrated Dermatologic Handbook"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Z&#46; Draelos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2005"
                        "editorial" => "CRC Press"
                        "editorialLocalizacion" => "London"
                      ]
                    ]
                  ]
                ]
              ]
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Revisão
Efeitos dos alisantes químicos na haste do pelo e no couro cabeludo: revisão
Joane Nathache Hatsbach de Paula
Corresponding author
joanedermatologista@gmail.com

Autor para correspondência.
, Flávia Machado Alves Basílio, Fabiane Andrade Mulinari‐Brenner
Departamento de Dermatologia, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brasil
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Os primeiros&#44; em geral&#44; decorrem do uso de alisantes &#225;cidos&#44; t&#234;m durabilidade vari&#225;vel e podem ter efeito cumulativo com aplica&#231;&#245;es sucessivas&#46; J&#225; os definitivos s&#227;o permanentes na &#225;rea do fio tratada e&#44; via de regra&#44; s&#227;o obtidos por meio de subst&#226;ncias alcalinas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Diversos compostos s&#227;o utilizados pela popula&#231;&#227;o para obter alisamento qu&#237;mico&#44; independentemente de sua libera&#231;&#227;o pela legisla&#231;&#227;o&#46; No Brasil&#44; a t&#233;cnica chamada de &#8220;escova progressiva&#8221; se difundiu com a utiliza&#231;&#227;o de alisantes &#225;cidos como o formalde&#237;do e o glutaralde&#237;do&#46; O procedimento foi disseminado mundialmente como tratamento brasileiro de queratina&#44; entre outras denomina&#231;&#245;es&#46; O formalde&#237;do &#233; classificado como uma subst&#226;ncia incolor&#44; altamente t&#243;xica e que&#44; &#224; temperatura ambiente&#44; &#233; um g&#225;s inflam&#225;vel&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">4</span></a> S&#227;o listados como sin&#244;nimos os termos metanal&#44; metil alde&#237;do&#44; &#243;xido de metileno&#44; formalina&#44; oximetileno&#44; alde&#237;do f&#243;rmico&#44; metilenoglicol&#44; <span class="elsevierStyleItalic">paraform</span> e oximetano&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">5&#44;6</span></a> Segundo a Ag&#234;ncia Nacional de Vigil&#226;ncia Sanit&#225;ria &#40;Anvisa&#41;&#44; formol e glutaralde&#237;do n&#227;o constam como alisantes&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">7</span></a> Recentemente&#44; t&#234;m sido utilizadas subst&#226;ncias que liberam formalde&#237;do apenas durante o processo de aquecimento&#44; como metilenoglicol&#44; &#225;cido gliox&#237;lico&#44; &#225;cido timon&#225;cico&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">5&#44;8</span></a> Os chamados &#8220;tratamentos seguros de queratina&#8221; utilizam &#225;cido gliox&#237;lico associado a carbociste&#237;na ou amino&#225;cidos&#44; derivados de silicone e &#225;cidos graxos&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A Instru&#231;&#227;o Normativa IN n&#176; 64<span class="elsevierStyleHsp" style=""></span>da Anvisa de 27&#47;07&#47;2020 estabeleceu&#44; nos termos da Resolu&#231;&#227;o de Diretoria Colegiada &#40;RDC&#41; n&#176; 409&#44; sua &#8220;Lista de ativos permitidos em produtos cosm&#233;ticos para alisar ou ondular os cabelos&#8221;&#44; onde constam&#58; &#225;cido tioglic&#243;lico e seus sais&#44; &#233;steres de &#225;cido tioglic&#243;lico&#44; hidr&#243;xido de s&#243;dio ou pot&#225;ssio&#44; hidr&#243;xido de l&#237;tio&#44; hidr&#243;xido de c&#225;lcio associado a sal de guanidina&#44; sulfitos e bissulfitos inorg&#226;nicos&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">10</span></a> Esses s&#227;o os alisantes tradicionais&#44; comumente referidos como relaxantes&#46; Embora existam diverg&#234;ncias&#44; de modo geral essa denomina&#231;&#227;o &#233; usada para designar os alisantes alcalinos&#46; Eles podem ser classificados em <span class="elsevierStyleItalic">lye</span> &#40;&#224; base de hidr&#243;xido de s&#243;dio&#41;&#44; <span class="elsevierStyleItalic">no&#8208;lye</span>&#44; tioglicolato de am&#244;nia e bissulfitos&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">3</span></a> Os hidr&#243;xidos s&#227;o divididos em <span class="elsevierStyleItalic">lye</span> e <span class="elsevierStyleItalic">no&#8208;lye</span>&#46; Alguns autores categorizam o tioglicolato no grupo dos <span class="elsevierStyleItalic">no&#8208;lye</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">O presente artigo tem como objetivo identificar as altera&#231;&#245;es na haste capilar e no couro cabeludo provocadas pelo uso de alisantes qu&#237;micos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Foi realizada busca nas bases de dados Pubmed&#44; Lilacs e Scielo usando os termos <span class="elsevierStyleItalic">hair straightening&#44; brazilian hair treatment&#44; brazilian blowout&#44; hair relaxer&#44; formaldehyde hair&#44; glyoxylic acid hair&#44; thioglycolic hair&#44; sodium hydroxide hair&#44; calcium hydroxide hair&#44; guanidine hair&#44; potassium hydroxide hair&#44; lithium hydroxide hair</span>&#44; alisamento cabelo&#44; escova progressiva&#44; relaxamento cabelo&#44; formalde&#237;do cabelo&#44; &#225;cido gliox&#237;lico cabelo&#44; tioglicolato cabelo&#44; hidr&#243;xido de s&#243;dio cabelo&#44; hidr&#243;xido de c&#225;lcio cabelo&#44; guanidina cabelo&#44; hidr&#243;xido de pot&#225;ssio cabelo&#44; hidr&#243;xido de l&#237;tio cabelo&#46; Foram inclu&#237;das publica&#231;&#245;es entre janeiro de 2000 a maio de 2020&#46; O per&#237;odo de busca da pesquisa foi de 16&#47;03&#47;2020 a 20&#47;05&#47;2020&#46; Obtiveram&#8208;se 703 resultados&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">O crit&#233;rio para inclus&#227;o dos artigos foi a tem&#225;tica de alisantes capilares e seus efeitos em couro cabeludo e haste capilar&#46; Foram exclu&#237;dos todos os resultados sem rela&#231;&#227;o com alisantes capilares&#44; pela leitura dos t&#237;tulos dos artigos&#46; A partir dos resumos dos artigos&#44; foram exclu&#237;dos artigos de revis&#227;o&#44; g&#234;nero cartas a editor e teses de doutorado &#40;inclu&#237;dos artigos decorrentes dessas teses publicados em revistas cient&#237;ficas&#41;&#46; Tamb&#233;m foram exclu&#237;dos artigos sobre o termo &#8220;permanente&#8221; pois&#44; apesar de as subst&#226;ncias se sobreporem aos alisantes qu&#237;micos&#44; a t&#233;cnica consiste em passos diferentes&#46; Exclu&#237;ram&#8208;se artigos referentes &#224; exposi&#231;&#227;o ocupacional &#224;s subst&#226;ncias qu&#237;micas dos alisantes e publica&#231;&#245;es que realizaram an&#225;lise das formula&#231;&#245;es sem investigar seus efeitos em haste ou couro cabeludo&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Estudos referentes a outras t&#233;cnicas capilares s&#243; deixaram de ser exclu&#237;dos quando as informa&#231;&#245;es se mesclavam &#224;s dos alisantes &#40;por exemplo&#58; associa&#231;&#227;o de t&#233;cnicas&#41; ou quando os alisamentos eram um dos assuntos estudados &#40;nesse caso&#44; a revis&#227;o englobou apenas as informa&#231;&#245;es sobre os alisantes&#41;&#46; Quando o artigo tratava conjuntamente de efeitos pesquisados e de efeitos colaterais sist&#234;micos&#44; os &#250;ltimos n&#227;o foram detalhados na revis&#227;o&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Portanto&#44; ap&#243;s a aplica&#231;&#227;o dos crit&#233;rios de inclus&#227;o e exclus&#227;o&#44; 649 artigos foram exclu&#237;dos&#46; A busca resultou em 33 artigos&#44; ap&#243;s a remo&#231;&#227;o de duplicatas&#44; selecionados para leitura e revis&#227;o&#46; Os m&#233;todos encontram&#8208;se esquematizados na <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Alisantes &#225;cidos&#58; formalde&#237;do&#44; outros alde&#237;dos e derivados do formalde&#237;do</span><p id="par0050" class="elsevierStylePara elsevierViewall">O formalde&#237;do pode causar dermatite de contato al&#233;rgica com gravidade progressiva a cada reexposi&#231;&#227;o&#44; com manifesta&#231;&#227;o cl&#237;nica de eczema em couro cabeludo e regi&#245;es adjacentes e edema em face&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Casos de eczema psoriasiforme em couro cabeludo&#44; face&#44; pesco&#231;o e tronco superior&#44; ocasionalmente com p&#250;stulas&#44; foram relatados ap&#243;s tratamento com escova de queratina brasileira&#46; A dermatoscopia revelou eritema e descama&#231;&#227;o interfolicular e perifolicular&#44; e a histopatologia demonstrou padr&#245;es psoriasiforme e espongi&#243;tico&#46; Aventou&#8208;se a possibilidade de que o formalde&#237;do n&#227;o cause les&#245;es apenas por dermatite de contato al&#233;rgica ou por irritante prim&#225;rio&#44; mas possa induzir rea&#231;&#245;es por outros mecanismos&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">13</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Quanto &#224;s altera&#231;&#245;es na haste capilar&#44; uma an&#225;lise comparativa das propriedades mec&#226;nicas dos fios ap&#243;s tratamento com formalde&#237;do e &#225;cido gliox&#237;lico mostrou&#44; em ambos&#44; redu&#231;&#227;o da resist&#234;ncia &#224; quebra&#44; da capta&#231;&#227;o e reten&#231;&#227;o de &#225;gua&#44; e da massa&#46; O cabelo tratado com formalde&#237;do apresentou aumento da irregularidade das cut&#237;culas&#44; potencializado com o uso de calor&#46; O &#225;cido gliox&#237;lico mostrou danos ainda maiores&#46; Essas seriam evid&#234;ncias dos efeitos nocivos dos produtos &#224; haste capilar&#44; a despeito dos achados de aumento da temperatura de desnatura&#231;&#227;o&#44; aus&#234;ncia de aumento de dano oxidativo&#44; e presen&#231;a de brilho observado ap&#243;s os tratamentos&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">14</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Sanad et al&#46; observaram melhor apar&#234;ncia macrosc&#243;pica&#44; correlata ao achado histopatol&#243;gico de diminui&#231;&#227;o de dano cuticular ap&#243;s uso de alisante de queratina contendo metilenoglicol&#44; em cabelos cacheados&#46; Na microscopia eletr&#244;nica&#44; em duas amostras houve aumento da densidade de matriz intermacrofibrilar no c&#243;rtex&#46; Ocorreu tamb&#233;m clareamento do cabelo em alguns indiv&#237;duos&#44; e relato de queda de cabelo em 13&#44;3&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">15</span></a> Em uma avalia&#231;&#227;o de fibras <span class="elsevierStyleItalic">yak</span> e cabelo humano&#44; realizada por Boga et al&#46;&#44; a amostragem tratada com &#225;cido gliox&#237;lico apresentou cut&#237;culas regulares&#59; j&#225; a tratada com solu&#231;&#227;o b&#225;sica e prancha modeladora mostrou mais irregularidades&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">16</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Goshiyama et al&#46;&#44; ao estudarem f&#243;rmulas com glioxiloil&#8208;carbociste&#237;na e glioxiloil&#8208;amino&#225;cidos de queratina&#44; demonstraram maior efeito alisante e mais danos em solu&#231;&#245;es mais &#225;cidas&#46; Alguns dos efeitos colaterais foram altera&#231;&#227;o da for&#231;a&#44; da colora&#231;&#227;o&#44; da entalpia e da quantidade de triptofano das hastes&#46; Na microscopia eletr&#244;nica&#44; notou&#8208;se um filme no cabelo tratado&#44; com sua cut&#237;cula mais selada&#44; parcialmente retirado ap&#243;s cinco lavagens&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">17</span></a> Os resultados est&#227;o dispostos nas <a class="elsevierStyleCrossRefs" href="#tbl0005">tabelas 1 e 2</a>&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">12&#8211;17</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Relaxantes capilares</span><p id="par0075" class="elsevierStylePara elsevierViewall">Os efeitos notados ap&#243;s mais de um alisamento com relaxante qu&#237;mico incluem aumento de <span class="elsevierStyleItalic">frizz</span>&#44; descama&#231;&#227;o do couro cabeludo&#44; perda de cabelo&#44; afinamento ou enfraquecimento do cabelo&#44; discromia dos fios&#44; tricoptilose&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">18</span></a> No Qu&#234;nia&#44; 67&#37; das mulheres com cabelo afro relataram efeitos sist&#234;micos e locais ap&#243;s utiliza&#231;&#227;o de relaxantes capilares de diferentes marcas&#46; Entre as manifesta&#231;&#245;es dermatol&#243;gicas&#44; foram citados&#58; dor e&#47;ou descama&#231;&#227;o no couro cabeludo&#44; rea&#231;&#245;es al&#233;rgicas&#44; atrofia da pele&#44; enfraquecimento e&#47;ou mudan&#231;a da cor do cabelo&#46; Os dois efeitos mais mencionados foram queimaduras e perda de cabelo&#46; A despeito dos efeitos colaterais&#44; 55&#37; optaram por manter algum tipo de alisamento&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">19</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Os impactos de um alisante de marca brasileira&#44; que apresentava dois produtos rotulados como &#8220;livres de qu&#237;mica&#8221; cujos pHs m&#233;dios testados foram de 1&#44;39 e 2&#44;82&#44; abrangeram efeitos graves como quebra ou perda de cabelo em 95&#37;&#44; perda de mais de 40&#37; do cabelo em 56&#37;&#44; aus&#234;ncia de repila&#231;&#227;o em 9&#37;&#44; al&#233;m de outras altera&#231;&#245;es nos fios e do couro cabeludo&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">20</span></a> O pH desses produtos divergiu do padr&#227;o alcalino dos relaxantes&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">20</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Al&#233;m dos efeitos cr&#244;nicos em couro cabeludo&#44; foram relatadas altera&#231;&#245;es agudas secund&#225;rias como em caso de paciente diab&#233;tica que&#44; ap&#243;s uso de hidr&#243;xido de c&#225;lcio&#44; desenvolveu sensa&#231;&#227;o de queima&#231;&#227;o na pele com dermatite de contato e evolu&#231;&#227;o para infec&#231;&#227;o com m&#250;ltiplos abscessos&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">21</span></a> Em pacientes que tiveram sintomas irritativos agudos em couro cabeludo durante processo de relaxamento&#44; ocorreu subsequente desenvolvimento de &#225;reas de alopecia cicatricial&#44; especialmente em v&#233;rtex&#44; com achados histol&#243;gicos sugestivos do diagn&#243;stico de alopecia cicatricial central centr&#237;fuga &#40;ACCC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">22</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Fatores relacionados com ACCC confirmada histologicamente foram investigados por Shah &#38; Alexis&#44; e o uso de alisantes foi o elemento mais comumente relatado nos pacientes com dados dispon&#237;veis&#46; No entanto&#44; em raz&#227;o da aus&#234;ncia de grupo controle&#44; n&#227;o foi poss&#237;vel estabelecer associa&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">23</span></a> Gathers et al&#46; e Olsen et al&#46; n&#227;o encontraram rela&#231;&#227;o dos relaxantes com o desenvolvimento de ACCC&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">24&#44;25</span></a> Entretanto&#44; Olsen et al&#46; encontraram associa&#231;&#227;o estatisticamente significativa entre a idade do primeiro relaxamento e a presen&#231;a de alopecia&#44; quando comparado o padr&#227;o sem alopecia com os padr&#245;es de alopecia mais avan&#231;ada &#40;ACCC prov&#225;vel&#41;&#46; A perda de cabelo n&#227;o impede o uso de relaxantes&#44; embora o diminua conforme sua gravidade aumenta&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">25</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Outros tipos de alopecias tamb&#233;m constituem preocupa&#231;&#227;o&#46; Em meninas afro&#8208;americanas&#44; nas quais a preval&#234;ncia de uso de relaxantes qu&#237;micos foi de 42&#37;&#44; o uso pr&#233;vio de relaxantes dobrou o risco de alopecia de tra&#231;&#227;o&#59; e quando associados a trancinhas rasteiras feitas h&#225; 12 meses&#44; a raz&#227;o de chances ultrapassa cinco&#46; Portanto&#44; h&#225; risco em tracionar cabelo relaxado em penteados apertados&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">26</span></a> Alguns indiv&#237;duos podem ter altera&#231;&#245;es estruturais relacionadas &#224; perda importante de cabelos&#46; Em uma mulher nigeriana at&#243;pica&#44; diagnosticou&#8208;se tricorrexe nodosa generalizada proximal ap&#243;s tr&#234;s epis&#243;dios de queda de cabelo universal&#44; relacionados a procedimentos de relaxamento&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">27</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Estudos t&#234;m explorado a distin&#231;&#227;o na resposta de fios de diferentes etnias ao alisamento&#46; Na avalia&#231;&#227;o de dano cuticular ap&#243;s processo de agita&#231;&#227;o dos fios em &#225;gua&#44; em amostras tratadas com alisante tiol&#44; houve maior suscetibilidade a danos no cabelo tratado&#44; proporcionalmente maior no cabelo chin&#234;s do que no caucasiano&#46; Na microscopia eletr&#244;nica&#44; demonstrou&#8208;se dano cuticular&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">28</span></a> Diversos procedimentos &#40;inclusive alisamentos&#41;&#44; de maneira associada ou n&#227;o&#44; em cabelos naturalmente pretos de diferentes texturas&#44; n&#227;o resultaram em diferen&#231;a vis&#237;vel no exame cl&#237;nico&#44; na dermatoscopia ou na microscopia de luz&#46; J&#225; na microscopia eletr&#244;nica sim&#44; de modo que houve diferen&#231;a significante entre os grupos&#44; com mais danos em quem realiza procedimentos em rela&#231;&#227;o ao grupo controle&#44; mas n&#227;o em rela&#231;&#227;o ao tipo de cabelo ou ao tratamento espec&#237;fico&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">29</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">O comportamento de cabelos caucasianos e cabelo afro no alisamento com tioglicolato divergiu&#46; A demanda de Joules para pentear o cabelo afro diminuiu&#44; mas n&#227;o houve diferen&#231;as dr&#225;sticas nos outros tipos de cabelo&#46; Na avalia&#231;&#227;o da colora&#231;&#227;o&#44; houve maior varia&#231;&#227;o nos cabelos castanho&#8208;escuros e nos afro&#8208;&#233;tnicos&#46; Cabelos virgens de tratamento apresentaram maior for&#231;a t&#234;nsil do que cabelos alisados em todos os tipos de cabelo&#44; e o uso do tioglicolato n&#227;o resultou em perdas adicionais de prote&#237;na ou triptofano&#44; exceto no cabelo afro&#46; Na microscopia eletr&#244;nica&#44; os cabelos castanho&#8208;escuros ondulados&#44; cacheados e afro tiveram discreta abertura das escamas&#44; rachaduras e quebra&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">30</span></a> De maneira oposta&#44; um estudo demonstrou que o cabelo africano foi mais resistente a estresse qu&#237;mico combinado&#46; Quando o alisamento foi combinado &#224; tintura comercial&#44; a cut&#237;cula e o c&#243;rtex africanos foram mais resistentes em rela&#231;&#227;o aos outros grupos &#233;tnicos&#46; Isso n&#227;o era esperado&#44; e talvez a mec&#226;nica pr&#243;pria do cabelo tenha sido alterada&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">31</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">O fio alisado fica mais vulner&#225;vel a outras t&#233;cnicas capilares somadas aos alisantes&#46; Foram encontradas &#225;reas de alopecia permanente onde havia sido aplicado implante capilar artificial do tipo n&#243; italiano ap&#243;s relaxamento&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">32</span></a> Os efeitos da combina&#231;&#227;o entre tintura e alisantes foram estudados em cabelo caucasiano castanho escuro e cacheado&#58; a tintura escolhida pelos pesquisadores e os alisantes aumentam&#44; em rela&#231;&#227;o ao cabelo virgem&#44; a perda de prote&#237;na durante a lavagem&#46; J&#225; quando os dois foram associados&#44; n&#227;o houve aumento adicional significativo nesses valores&#44; exceto para o hidr&#243;xido de s&#243;dio&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">11</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Altera&#231;&#245;es foram demonstradas tamb&#233;m em n&#237;vel molecular&#46; Em amostras de cabelo liso expostas ao hidr&#243;xido de s&#243;dio houve aumento de altera&#231;&#245;es oxidativas&#44; aumento de forma&#231;&#227;o de desidroalanina&#44; desidrata&#231;&#227;o da cadeia lateral e dano &#224; ciste&#237;na&#44; que provavelmente corresponde a dano estrutural&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">33</span></a> A integridade proteica&#44; representada pelo n&#237;vel de triptofano e outros produtos de sua degrada&#231;&#227;o&#44; foi estudada em resposta a danos ap&#243;s alisamento com creme relaxante <span class="elsevierStyleItalic">lye</span>&#46; A fluoresc&#234;ncia para triptofano diminuiu&#44; mas n&#227;o houve diferen&#231;a nas quinureninas &#40;um dos metab&#243;litos do triptofano&#41;&#44; o que pode significar ocorr&#234;ncia de degrada&#231;&#227;o tanto do triptofano quanto de seus metab&#243;litos pelo processo qu&#237;mico&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">34</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Cabelos brancos afro e caucasiano foram submetidos a alisamento com tioglicolato de am&#244;nia ou tratamento triplo com o mesmo alisante associado &#224; descolora&#231;&#227;o com am&#244;nia e per&#243;xido de hidrog&#234;nio e tamb&#233;m &#224; prancha alisante&#46; Ap&#243;s os tratamentos&#44; liga&#231;&#245;es importantes foram alteradas&#44; com pequenas diferen&#231;as entre as etnias&#46; O alisamento teve maior a&#231;&#227;o na banda pertencente ao &#225;cido cisteico e acarretou em les&#245;es na fibra&#44; com irregularidades e destacamento cuticular&#44; e pequenas ondula&#231;&#245;es em sua extens&#227;o&#46; O tratamento triplo demonstrou hastes com contornos irregulares&#44; destacamento e deforma&#231;&#227;o cuticular&#44; e tamb&#233;m poss&#237;vel dano cortical&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">35</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Ao comparar um produto A &#40;<span class="elsevierStyleItalic">lye</span>&#41; com um produto B &#40;<span class="elsevierStyleItalic">no&#8208;lye</span>&#44; com hidr&#243;xido de guanidina&#41;&#44; Mamabolo et al&#46; evidenciaram&#44; na haste&#44; diminui&#231;&#227;o de cistina ap&#243;s o tratamento com os dois produtos&#44; com maior perda com o uso do produto B&#46; A redu&#231;&#227;o da cistina foi acompanhada de maior atividade alisante&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">36</span></a> N&#227;o houve diferen&#231;a significativa na tolerabilidade dos dois produtos no couro cabeludo&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">36</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Khumalo et al&#46; encontraram diferen&#231;a na quantidade de quatro amino&#225;cidos entre os grupos com alisamento e o grupo sem&#58; cistina&#44; citrulina&#44; arginina e glutamina&#46; Os n&#237;veis de cistina no cabelo tratado foram similares aos encontrados em tricotiodistrofia&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">37</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Com foco nas altera&#231;&#245;es inflamat&#243;rias&#44; Beach et al&#46; coletaram algumas citocinas no sebo do couro cabeludo de mulheres que realizaram procedimentos com subst&#226;ncias relaxantes ou permaneceram com cabelos naturais&#46; Em n&#237;veis suficientes para interpreta&#231;&#227;o&#44; foram detectadas a IL&#8208;1&#945; &#40;pr&#243;&#8208;inflamat&#243;ria&#41; e a IL&#8208;1ra &#40;antiinflamat&#243;ria&#41;&#44; e embora diferen&#231;as das citocinas entre o v&#233;rtex e a coroa possam refletir predisposi&#231;&#227;o distinta dos locais do couro cabeludo &#224; inflama&#231;&#227;o&#44; n&#227;o se conseguiu demonstrar mudan&#231;as nas citocinas inflamat&#243;rias espec&#237;ficas ap&#243;s uso de relaxantes&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">38</span></a> Tackey et al&#46;&#44; utilizando um modelo de epiderme tridimensional&#44; compararam alisantes <span class="elsevierStyleItalic">lye</span> e <span class="elsevierStyleItalic">no&#8208;lye</span> pareados com controles n&#227;o tratados&#44; em rela&#231;&#227;o a citocinas envolvidas na modula&#231;&#227;o de irrita&#231;&#227;o ap&#243;s alisamento&#46; A IL&#8208;1&#945; atingiu n&#237;veis maiores em 24 e 48 horas ap&#243;s o uso de alisante <span class="elsevierStyleItalic">no&#8208;lye</span>&#46; Ambos os alisantes resultaram em n&#237;veis de prostaglandina E2 &#40;PGE2&#41; maiores do que os controles em todos os per&#237;odos avaliados&#44; e a citocina poderia ter responsabilidade sobre as diferen&#231;as sensoriais entre os diversos tipos de produtos&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">39</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Agentes condicionantes e protetores podem minimizar os danos causados pelos alisantes&#44; e sua interfer&#234;ncia na efic&#225;cia do alisamento &#233; controversa&#46;<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">40&#8211;42</span></a> Os achados encontram&#8208;se sintetizados nas <a class="elsevierStyleCrossRefs" href="#tbl0015">tabelas 3 a 7</a>&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">11&#44;18&#8211;43</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Alisantes em geral</span><p id="par0145" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; exposi&#231;&#227;o a alisantes&#44; Marks et al&#46; compararam pacientes com alopecia cicatricial e pacientes com alopecia n&#227;o cicatricial &#40;grupo controle&#41;&#46; Houve diferen&#231;a significativa nos grupos sobre a hist&#243;ria pr&#233;via de alisamento qu&#237;mico &#40;25&#37; no grupo com alopecia cicatricial e 13&#37; no grupo n&#227;o cicatricial&#41;&#44; decorrente especialmente do papel dos pacientes com l&#237;quen plano pilar e AFF&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">43</span></a> Esse estudo n&#227;o especifica quais alisantes foram utilizados pelos indiv&#237;duos&#44; mas cita como exemplos hidr&#243;xido de s&#243;dio e glutaralde&#237;do&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">43</span></a> O resumo dos resultados encontra&#8208;se na <a class="elsevierStyleCrossRef" href="#tbl0040">tabela 8</a>&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">43</span></a></p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Discuss&#227;o</span><p id="par0150" class="elsevierStylePara elsevierViewall">Os alisantes baseados em formalde&#237;do ou derivados s&#227;o&#44; em geral&#44; compostos por alde&#237;do e prote&#237;nas como a queratina hidrolisada&#58; ap&#243;s exposi&#231;&#227;o ao calor&#44; o alde&#237;do promoveria <span class="elsevierStyleItalic">cross&#8208;link</span> entre as queratinas do produto e as do cabelo&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">9</span></a> Supostamente&#44; o alisamento se d&#225; pela difus&#227;o da queratina para o c&#243;rtex preenchendo os defeitos e reestruturando o fio&#59; no entanto&#44; n&#227;o h&#225; evid&#234;ncias desse efeito&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">9</span></a> O uso de formalde&#237;do e glutaralde&#237;do como alisantes n&#227;o &#233; permitido no Brasil&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">7</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Os produtos com &#225;cido gliox&#237;lico s&#227;o citados no site da Anvisa como glioxiloil&#8208;carbociste&#237;na e glioxiloil&#8208;amino&#225;cidos de queratina na sess&#227;o &#8220;orienta&#231;&#245;es sobre os alisantes &#8211; o que devo encontrar no r&#243;tulo desses produtos&#8221;&#44; com a ressalva de que devem alertar o consumidor sobre o risco de queda ou de altera&#231;&#227;o de cor dos cabelos&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">7</span></a> Por&#233;m&#44; a subst&#226;ncia n&#227;o consta na IN n&#176; 64 do &#243;rg&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">10</span></a> A carbociste&#237;na n&#227;o &#233; um alisante quando utilizada isoladamente&#44; mas geralmente &#233; formulada com o &#225;cido gliox&#237;lico&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">8</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Os alisantes &#225;cidos continuam sendo uma constante em produtos de alisamento&#46; Localmente&#44; o formalde&#237;do pode causar dermatite&#44; inclusive eczema al&#233;rgico e eczema psoriasiforme&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">12&#44;13</span></a> O relato na literatura m&#233;dica das rea&#231;&#245;es em couro cabeludo pode ser subestimado&#44; pois a dermatite de contato irritativa ap&#243;s o uso do formalde&#237;do &#233; frequentemente considerada um efeito normal pelos usu&#225;rios&#46; Na haste capilar&#44; o formalde&#237;do e o &#225;cido gliox&#237;lico&#44; a despeito do brilho no aspecto macrosc&#243;pico&#44; pioraram a irregularidade das cut&#237;culas &#224; microscopia eletr&#244;nica e diminu&#237;ram a resist&#234;ncia &#224; quebra&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">14</span></a> No entanto&#44; outros estudos n&#227;o demonstraram o mesmo dano&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">15&#44;16</span></a> Embora haja altera&#231;&#245;es na for&#231;a&#44; na colora&#231;&#227;o do cabelo e outras evid&#234;ncias de dano &#224; haste&#44; o trabalho para pentear diminui com os alisantes &#225;cidos&#44; como demonstrado em estudo com &#225;cido gliox&#237;lico&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">17</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">J&#225; os alisantes permitidos por lei no Brasil s&#227;o os previstos na IN n&#176; 64<span class="elsevierStyleHsp" style=""></span>da ANVISA&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">10</span></a> Os hidr&#243;xidos agem em raz&#227;o de seu alto pH&#44; abrindo as cut&#237;culas e propiciando a a&#231;&#227;o do agente alcalino redutor no c&#243;rtex&#44; onde as liga&#231;&#245;es dissulfeto s&#227;o quebradas&#46; O cabelo &#233; ent&#227;o mecanicamente alisado&#44; com reestrutura&#231;&#227;o das liga&#231;&#245;es entre as queratinas&#46; Em seguida&#44; o cabelo &#233; exposto &#224; subst&#226;ncia &#225;cida para encerrar o processo e fechar as cut&#237;culas &#40;processo de neutraliza&#231;&#227;o&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">1&#44;8&#44;44</span></a> Os &#225;lcalis reagem com a cistina e produzem a lantionina&#44; na chamada lantioniza&#231;&#227;o&#46; Esse processo substitui um ter&#231;o da cistina por lantionina&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">8</span></a> N&#227;o existe necessidade de calor ou tra&#231;&#227;o externa&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">8</span></a> Diferentemente&#44; o tioglicolato n&#227;o age por lantioniza&#231;&#227;o&#44; mas por redu&#231;&#227;o seletiva das liga&#231;&#245;es de cistina sem alterar a prote&#237;na inteira&#44; &#233; neutralizado com per&#243;xido de hidrog&#234;nio ou bromato de s&#243;dio e as liga&#231;&#245;es s&#227;o rearranjadas&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">8&#44;44</span></a> O calor deve ser aplicado para o passo de tratamento t&#233;rmico&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">8&#44;44</span></a> Seu uso &#233; comumente chamado de &#8220;escova japonesa&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">8</span></a> Mant&#234;m&#8208;se 90&#37; do conte&#250;do de cistina e 10&#37; tornam&#8208;se &#225;cido cisteico&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">8</span></a> Existe ainda o bissulfito de am&#244;nia&#44; menos agressivo&#44; menos efetivo e mais empregado em produtos de uso domiciliar&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">3</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Os alisantes do tipo relaxantes n&#227;o s&#227;o isentos de efeitos colaterais&#46; T&#234;m sido citados alergias&#44; <span class="elsevierStyleItalic">frizz</span> na haste&#44; cabelos secos&#44; afinamento e enfraquecimento do fio&#44; tricoptilose e altera&#231;&#227;o de colora&#231;&#227;o dos cabelos&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">18&#8211;20&#44;30</span></a> No couro cabeludo&#44; s&#227;o descritos descama&#231;&#227;o&#44; dor&#44; atrofia&#44; at&#233; queimaduras e quadros potencialmente graves de eczema de contato com infec&#231;&#227;o secund&#225;ria&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">18&#8211;21</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">As consequ&#234;ncias da inflama&#231;&#227;o aguda a longo prazo n&#227;o s&#227;o conhecidas&#44; mas aventa&#8208;se at&#233; rela&#231;&#227;o com alopecia cicatricial central centr&#237;fuga&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">22</span></a> Uma hip&#243;tese seria que altera&#231;&#245;es de citocinas causadas por alisantes possam exercer algum papel no processo inflamat&#243;rio&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">38</span></a> A rela&#231;&#227;o das citocinas&#44; inclusive com as diferen&#231;as sensoriais entre os tipos de produtos&#44; tem sido estudada&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">39</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">A perda de cabelo tamb&#233;m tem sido relacionada&#44; inclusive com alopecia irrevers&#237;vel&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">18&#8211;20</span></a> Os dados referentes &#224; associa&#231;&#227;o com ACCC divergem&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">23&#8211;25&#44;43</span></a> Existe aumento do risco de alopecia de tra&#231;&#227;o com relaxantes&#44; especialmente se associados a tran&#231;as rasteiras&#44; e tricorrexe nodosa generalizada proximal foi relacionada a alisamentos&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Na haste&#44; com o uso dos relaxantes&#44; h&#225; ocorr&#234;ncia de aumento da dist&#226;ncia inter&#8208;escamas&#44; abertura das escamas&#44; irregularidade de suas bordas&#44; rachaduras&#44; grave levantamento da cut&#237;cula com exposi&#231;&#227;o do c&#243;rtex&#44; les&#245;es na fibra&#44; aumento das part&#237;culas extra&#237;das do fio&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">28&#8211;30&#44;35</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">O uso de alisantes concomitantemente a outras t&#233;cnicas capilares parece aumentar a vulnerabilidade a danos&#46; Relaxamentos capilares somados ao uso de implante capilar artificial relacionaram&#8208;se com &#225;reas de alopecia permanente&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">32</span></a> Relaxantes resultaram em maior propens&#227;o &#224; perda proteica&#44; e&#44; quando associado &#224; tintura&#44; o hidr&#243;xido de s&#243;dio mostrou&#8208;se ainda mais agressivo&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">11</span></a> A somat&#243;ria de alisamento com tioglicolato de am&#244;nia&#44; descolora&#231;&#227;o e prancha alisante resultou em hastes com contornos irregulares&#44; destacamento e deforma&#231;&#227;o cuticular e poss&#237;vel dano cortical&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">35</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Com alisantes <span class="elsevierStyleItalic">lye</span> e <span class="elsevierStyleItalic">no&#8208;lye</span> foi encontrada diferen&#231;a na quantidade de amino&#225;cidos em rela&#231;&#227;o ao cabelo virgem&#46; &#201; not&#243;ria a diminui&#231;&#227;o de cistina&#44; presente nas liga&#231;&#245;es dissulfeto que d&#227;o for&#231;a ao cabelo&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">37</span></a> A n&#237;vel molecular&#44; em cabelo liso europeu exposto a hidr&#243;xido de s&#243;dio houve deteriora&#231;&#227;o da ciste&#237;na&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">33</span></a> Alisamento com relaxante <span class="elsevierStyleItalic">lye</span> degradou triptofano&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">34</span></a> Entretanto&#44; o uso do tioglicolato n&#227;o resultou em perdas adicionais de prote&#237;na ou triptofano&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">30</span></a> Comparando alisante <span class="elsevierStyleItalic">lye</span> e <span class="elsevierStyleItalic">no&#8208;lye</span> houve redu&#231;&#227;o de cistina ap&#243;s ambos&#44; com maior perda com <span class="elsevierStyleItalic">no&#8208;lye</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">36</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Cabelos de etnias diferentes parecem divergir na suscetibilidade ao alisamento&#44; com achados variados na literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">31&#44;35</span></a> Os danos estruturais podem ser minimizados por agentes condicionantes&#44; algumas ceramidas e ceras&#46;<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">40&#8211;42</span></a> Apesar dos efeitos colaterais&#44; muitas mulheres optam por manter os alisamentos&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">19&#44;25</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">As limita&#231;&#245;es do estudo foram&#58; busca restrita a apenas tr&#234;s bases de dados&#59; busca em apenas dois idiomas&#59; escassez de pesquisas resultando em baixo rigor cient&#237;fico para inclus&#227;o de artigos&#59; aceite de diversos desenhos de estudo&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclus&#227;o</span><p id="par0210" class="elsevierStylePara elsevierViewall">A revis&#227;o de dados referentes aos &#250;ltimos 20 anos&#44; mesmo com limita&#231;&#245;es&#44; retrata a ocorr&#234;ncia expressiva de altera&#231;&#245;es em haste capilar e couro cabeludo secund&#225;rias aos alisamentos capilares&#46; Inflama&#231;&#227;o cl&#237;nica e subcl&#237;nica do couro cabeludo&#44; danos &#224; haste&#44; perda de cabelo por fratura do fio ficaram evidentes&#46; Os efeitos a longo prazo ainda permanecem desconhecidos&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Os profissionais de sa&#250;de&#44; especialmente o m&#233;dico dermatologista&#44; assim como os profissionais de sal&#245;es de beleza e seus clientes precisam conhecer os riscos e benef&#237;cios desses tratamentos qu&#237;micos&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">A recente norma da Anvisa limita o registro de alisantes&#44; mas n&#227;o esclarece quanto aos novos &#8220;alisantes &#225;cidos&#8221;&#44; como o &#225;cido gliox&#237;lico&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">10</span></a> Os efeitos dos alisantes &#225;cidos est&#227;o em voga especialmente por conta do estudo multic&#234;ntrico brasileiro que levantou a hip&#243;tese da associa&#231;&#227;o da alopecia frontal fibrosante com procedimentos de alisamento com formol&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">45</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Estudos com rigor cient&#237;fico s&#227;o necess&#225;rios para compreender melhor as respostas das estruturas capilares aos agentes qu&#237;micos&#44; 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                  \t\t\t\t">Leite &#38; Maia Campos&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">14</span></a> 2017</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amostras de cabelo cacheado</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#193;cido gliox&#237;lico e formalde&#237;do</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">Redu&#231;&#227;o da resist&#234;ncia &#224; quebra e da massa capilar&#44; menor capta&#231;&#227;o e reten&#231;&#227;o de &#225;gua&#44; aumento da irregularidade cuticular&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento da temperatura de desnatura&#231;&#227;o&#44; dano oxidativo est&#225;vel&nbsp;\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  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sanad et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">15</span></a> 2019</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30 &#40;F&#58;30 M&#58;0&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metilenoglicol</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">Aumento da maciez e brilho &#224; macroscopia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tricoptilose e fissuras transversais sem modifica&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Redu&#231;&#227;o de danos cuticular &#224; histopatologia&#44; mas aus&#234;ncia de reparo cuticular &#224; microscopia eletr&#244;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento da densidade de matriz intermacrofibrilar no c&#243;rtex &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clareamento da haste &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Queda de cabelo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Boga et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">16</span></a> 2014&nbsp;\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">Ensaio cl&#237;nico&nbsp;\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">Fibras <span class="elsevierStyleItalic">yak</span> e cabelo humano&nbsp;\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">&#193;cido Gliox&#237;lico&nbsp;\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">Persist&#234;ncia da regularidade cuticular &#224; microscopia eletr&#244;nica&nbsp;\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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Goshiyama et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">17</span></a> 2020</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amostras de cabelo cacheado castanho escuro</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">glioxiloil&#8208;carbociste&#237;na e glioxiloil&#8208;amino&#225;cidos de queratina</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">Redu&#231;&#227;o do trabalho para pentear de&#58; 59&#44;4&#37; &#40;pH 1&#44;0&#41;&#44; 33&#44;3&#37; &#40;pH 2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Redu&#231;&#227;o da for&#231;a da haste em&#58; 15&#44;7&#37; &#40;pH 1&#44;0&#41;&#44; 8&#44;7&#37; &#40;pH 2&#44;0&#41;&#46; Sem signific&#226;ncia estat&#237;stica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambos os pHs&#58; altera&#231;&#227;o de colora&#231;&#227;o&#44; redu&#231;&#227;o na entalpia das hastes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudos sobre os efeitos dos alisantes &#225;cidos na haste do cabelo</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">n<span class="elsevierStyleItalic">&#44;</span> n&#250;mero de pacientes&#59; F&#44; feminino&#59; M&#44; masculino&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th 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" scope="col" style="border-bottom: 2px solid black">Autor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Tipo de estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Agente alisante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#245;es em haste e em couro cabeludo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shetty et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">18</span></a> 2013</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transversal &#40;question&#225;rio&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>90 &#40;F&#58;90&#44; M&#58;0&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relaxantes qu&#237;micos</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">Aumento do <span class="elsevierStyleItalic">frizz</span> &#40;67&#37; dos casos&#41;&#44; afinamento ou enfraquecimento do cabelo &#40;40&#37;&#41;&#44; discromia &#40;acinzentamento&#41; do cabelo &#40;22&#37;&#41;&#44; tricoptilose &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Descama&#231;&#227;o do couro cabeludo &#40;61&#37;&#41; e perda de cabelo &#40;47&#37;&#41;&nbsp;\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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Etemesi BA&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">19</span></a> 2007</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transversal &#40;question&#225;rio&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">242 &#40;F&#58;242&#44; M&#58;0&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relaxantes qu&#237;micos</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">Enfraquecimento e&#47;ou mudan&#231;a da cor do cabelo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor e&#47;ou descama&#231;&#227;o no couro cabeludo&#44; rea&#231;&#245;es al&#233;rgicas&#44; afinamento da pele&#44; queimaduras e perda de cabelo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kaur et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">21</span></a> 2002&nbsp;\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">Relato de caso&nbsp;\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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1 &#40;F&#58;1&#41;&nbsp;\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">Hidr&#243;xido de c&#225;lcio&nbsp;\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">Eczema de contato e infec&#231;&#227;o estafiloc&#243;cica secund&#225;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Autor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \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" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#245;es em haste e em couro cabeludo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Swee et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">20</span></a> 2000</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transversal &#40;question&#225;rio&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>464 &#40;F&#58;457&#44; M&#58;5&#44; n&#227;o identificado&#58; 2&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relaxante &#225;cido &#40;n&#227;o tradicional&#41; com sais met&#225;licos</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">Quebra ou perda de cabelo &#40;95&#37; dos casos&#41;&#44; cabelos secos ou &#225;speros &#40;70&#37;&#41;&#44; descolora&#231;&#227;o do cabelo &#40;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Couro cabeludo seco &#40;53&#37;&#41;&#44; dor em queima&#231;&#227;o em couro cabeludo &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Estudo que avaliou sinais e sintomas de relaxante capilar &#40;relaxante &#225;cido n&#227;o tradicional&#41;</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">n&#44; n&#250;mero de pacientes&#59; F&#44; feminino&#59; M&#44; masculino&#46;</p>"
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              "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"><th 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" scope="col" style="border-bottom: 2px solid black">Autor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Tipo de estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Alisante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#245;es em couro cabeludo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Khumalo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">22</span></a> 2007</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#233;rie de casos</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5 &#40;M&#58;5&#44; H&#58;0&#41;</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">Hidr&#243;xido de s&#243;dio &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\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">Sintomas irritativos e desenvolvimento de &#225;reas de alopecia cicatricial&#46; Achados histol&#243;gicos de infiltrado linfoc&#237;tico perifolicular&#44; fibrose folicular e descama&#231;&#227;o prematura da bainha radicular interna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidr&#243;xido de guanidina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shah &#38; Alexis&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">23</span></a> 2010&nbsp;\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">S&#233;rie de casos&nbsp;\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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>69 &#40;M&#58;67&#44; H&#58;2&#41; &#40;64&#58; dados sobre cuidados com cabelos&#41;&nbsp;\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">Relaxantes qu&#237;micos&nbsp;\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">Alisantes foram a pr&#225;tica traum&#225;tica mais comum em pacientes com ACCC&#46; N&#227;o foi poss&#237;vel estabelecer associa&#231;&#227;o devido &#224; aus&#234;ncia de grupo controle&nbsp;\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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gathers et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">24</span></a> 2009</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caso&#8208;controle</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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>101 &#40;M&#58;101&#44; H&#58;0&#41;&nbsp;\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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relaxantes qu&#237;micos</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sem rela&#231;&#227;o de uso de relaxantes&#44; de sua frequ&#234;ncia de aplica&#231;&#227;o ou de complica&#231;&#245;es de seu uso com o desenvolvimento de ACCC</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo ACCC &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo sem alopecia cicatricial &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;&nbsp;\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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Olsen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">25</span></a> 2011</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caso&#8208;controle</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>529 &#40;M&#58;529&#44; H&#58;0&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relaxantes qu&#237;micos</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">Sem associa&#231;&#227;o do uso de relaxantes ou de rea&#231;&#227;o a eles com queda extensa central de cabelo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Associa&#231;&#227;o entre a idade do primeiro relaxamento e o padr&#227;o de perda quando comparado o padr&#227;o 0 &#40;sem perda&#41; <span class="elsevierStyleItalic">vs</span>&#46; os padr&#245;es 3 e 5 &#40;ACCC prov&#225;vel&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rucker et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">26</span></a> 2011&#46;&nbsp;\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">Transversal &#40;question&#225;rio&#41;&nbsp;\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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>201 &#40;M&#58;201&#44; H&#58;0&#41;&nbsp;\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">Relaxantes qu&#237;micos&nbsp;\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">Relaxamento foi fator de risco para alopecia de tra&#231;&#227;o &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;2&#59; &#40;95&#37; CI 1&#44;1&#8211;4&#44;5&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;No relaxamento associado a trancinhas rasteiras&#58; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44;27 &#40;95&#37; CI 1&#44;5&#8211;18&#44;32&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ogunbiyi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">27</span></a> 2014&nbsp;\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">Relato de caso&nbsp;\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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1 &#40;F&#58;1&#41;&nbsp;\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">Relaxantes qu&#237;micos&nbsp;\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">Perda de cabelos relacionada &#224; tricorrexe nodosa generalizada proximal&#44; com atopia como condi&#231;&#227;o basal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amorim et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">32</span></a> 2017&nbsp;\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">Transversal&nbsp;\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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30 &#40;F&#58;30&#44; M&#58;0&#41;&nbsp;\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">Hidr&#243;xido de s&#243;dio ou hidr&#243;xido de guanidina&nbsp;\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">Quando associados a implante capilar artificial do tipo n&#243; italiano&#44; relacionaram&#8208;se com &#225;reas de alopecia permanente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">n&#44; n&#250;mero de pacientes&#59; F&#44; feminino&#59; M&#44; masculino&#46;</p>"
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            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"><th 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" scope="col" style="border-bottom: 2px solid black">Autor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Tipo de estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Alisante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#245;es em haste e couro cabeludo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Galliano et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">28</span></a> 2010</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12 &#40;6 amostras de cabelo chinesas e 6 amostras de cabelo caucasianas&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alisante tiol</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">Aumento da dist&#226;ncia inter&#8208;escamas&#44; da inclina&#231;&#227;o das escamas e da irregularidade de suas bordas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#233;dia de tamanho das part&#237;culas extra&#237;das do cabelo ap&#243;s agita&#231;&#227;o em &#225;gua por 30 minutos&#58; diferente entre as etnias e aumento proporcionalmente maior no cabelo chin&#234;s&nbsp;\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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kaliyadan et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">29</span></a> 2016</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transversal</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25 &#40;F&#58;25&#41; &#40;19 sujeitos e 6 controles&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relaxantes qu&#237;micos</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 alisamento isolado &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#58; o cabelo cacheado teve dano grau 2 &#40;grave levantamento da cut&#237;cula&#44; rachaduras ou buracos com exposi&#231;&#227;o do c&#243;rtex&#41; e o cabelo ondulado grau 0 &#40;cut&#237;cula intacta&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No alisamento associado a colora&#231;&#227;o &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&#58; graus de dano de 1 &#40;cut&#237;cula irregular sem rachaduras ou buracos&#41; a 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Na associa&#231;&#227;o de alisamento&#44; descolora&#231;&#227;o e colora&#231;&#227;o &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#58; dano grau 3 &#40;c&#243;rtex parcialmente exposto&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No grupo controle &#40;cabelo ondulado ou liso&#41;&#58; grau de dano de 0 a 1&nbsp;\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  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bloch et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">30</span></a> 2019</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amostras de cabelo caucasiano &#40;liso castanho escuro&#59; liso loiro&#59; ondulado castanho escuro&#59; e cacheado castanho escuro&#41; e cabelo afro</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tioglicolato de am&#244;nia</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">Redu&#231;&#227;o de 71&#37; no trabalho &#40;em Joules&#41; para pentear os cabelos afro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maior varia&#231;&#227;o de colora&#231;&#227;o nos cabelos castanho escuros e nos afro&#8208;&#233;tnicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diminui&#231;&#227;o de for&#231;a t&#234;nsil em todos os tipos de cabelo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sem perdas adicionais de prote&#237;na ou triptofano &#40;exceto no cabelo afro&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabelos castanho escuros ondulados&#44; cacheados e afro&#58; discreta abertura das escamas&#44; rachaduras e quebra&nbsp;\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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lee et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">31</span></a> 2014</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amostras de cabelo asi&#225;tico&#44; caucasiano europeu e afro&#8208;americano</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tioglicolato de am&#244;nia</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 alisamento&#58; as cut&#237;culas dos cabelos asi&#225;ticos foram as mais resistentes&#46; O dano ao c&#243;rtex foi similar nos tr&#234;s grupos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No alisamento combinado &#224; tintura comercial&#58; a cut&#237;cula e c&#243;rtex africanos foram as mais resistentes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Os tr&#234;s grupos apresentaram padr&#245;es semelhantes de dano &#224; membrana celular ap&#243;s o alisamento ou alisamento combinado com tintura&nbsp;\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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fran&#231;a&#8208;Stefoni et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">11</span></a> 2015</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabelo caucasiano castanho escuro e cacheado</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tioglicolato de am&#244;nia&#44; hidr&#243;xido de guanidina&#44; hidr&#243;xido de s&#243;dio</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">Perda proteica adicional na lavagem&#58; tintura &#40;48&#37;&#41;&#44; tioglicolato de am&#244;nia &#40;159&#37;&#41;&#59; hidr&#243;xido de guanidina &#40;188&#37;&#41;&#59; hidr&#243;xido de s&#243;dio &#40;276&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quando associados &#224; tintura&#44; o tioglicolato de am&#244;nia e hidr&#243;xido de guanidina n&#227;o causaram aumento adicional significante na perda proteica&#46; O hidr&#243;xido de s&#243;dio sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dyer et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">33</span></a> 2013&nbsp;\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">Ensaio cl&#237;nico&nbsp;\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">Amostras de cabelo liso europeu&nbsp;\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">Hidr&#243;xido de s&#243;dio&nbsp;\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">Aumento de altera&#231;&#245;es oxidativas&#44; danos associados a &#225;lcali&#44; aumento de forma&#231;&#227;o de desidroalanina e desidrata&#231;&#227;o da cadeia lateral&#44; e dano &#224; ciste&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">McMullen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">34</span></a> 2011&nbsp;\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">Ensaio cl&#237;nico&nbsp;\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">Amostras de cabelos europeus castanhos escuros e cabelos <span class="elsevierStyleItalic">Piedmont</span>&nbsp;\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">Hidr&#243;xido de s&#243;dio&nbsp;\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">Degrada&#231;&#227;o de triptofano e seus metab&#243;litos&nbsp;\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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dos Santos et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">35</span></a> 2019</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amostras de cabelos brancos afro e caucasiano</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tioglicolato de am&#244;nia</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">Les&#245;es na fibra&#44; com irregularidades e destacamento cuticular&#44; e pequenas ondula&#231;&#245;es em sua extens&#227;o&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Associa&#231;&#227;o de alisamento com descolora&#231;&#227;o e prancha alisante&#58; hastes com contornos irregulares&#44; destacamento e deforma&#231;&#227;o cuticular&#44; e poss&#237;vel dano cortical&#46;&nbsp;\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  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mamabolo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">36</span></a> 2013</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#58; 5 &#40;F&#58;5&#44; M&#58;0&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidr&#243;xido de s&#243;dio e Hidr&#243;xido de Guanidina</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">Hidr&#243;xido de guanidina&#58; maior maciez&#44; aspecto liso&#44; brilho&#44; e menos aspecto seco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Os dois produtos foram similares quanto ao dano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O alisante <span class="elsevierStyleItalic">no&#8208;lye</span> obteve menos pontas duplas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O conte&#250;do de cistina reduzido com o alisante <span class="elsevierStyleItalic">lye</span> e de forma mais intensa com o alisante <span class="elsevierStyleItalic">no&#8208;lye</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A lisina diminuiu em rela&#231;&#227;o ao cabelo virgem para os dois alisantes&#44; no entanto sem diferen&#231;a estat&#237;stica entre eles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Khumalo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">37</span></a> 2010&nbsp;\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">Coorte hist&#243;rica&nbsp;\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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&nbsp;\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">Relaxantes qu&#237;micos&nbsp;\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">A cistina&#44; a citrulina &#40;nem sempre com signific&#226;ncia estat&#237;stica&#41; e a arginina diminu&#237;ram e a glutamina aumentou nos cabelos relaxados&#46; Os n&#237;veis de cistina foram menores no cabelo tratado do que no cabelo virgem&#44; com n&#237;veis similares aos encontrados em tricotiodistrofia&nbsp;\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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Beach et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">38</span></a> 2012&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36 &#40;F&#58;30&#44; M&#58;0&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidr&#243;xido de guanidina&#44; hidr&#243;xido de s&#243;dio&#44; tioglicolato de am&#244;nia</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">IL&#8208;1&#945; e IL&#8208;1ra foram detectadas no couro cabeludo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ap&#243;s o alisamento&#44; os n&#237;veis de IL&#8208;1&#945; e IL&#8208;1ra na coroa e v&#233;rtex foram menores&#44; mas sem diferen&#231;a em rela&#231;&#227;o ao grupo que n&#227;o aliso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o se conseguiu demonstrar mudan&#231;as nas citocinas inflamat&#243;rias espec&#237;ficas ap&#243;s uso de relaxantes&nbsp;\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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tackey et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">39</span></a> 2013</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Modelo de epiderme tridimensional</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidr&#243;xido de s&#243;dio&#44; hidr&#243;xido de guanidina</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">IL&#8208;1&#945;&#58; em 4h da aplica&#231;&#227;o n&#227;o mostrou diferen&#231;a significativa entre os grupos de alisantes&#44; e em 24h e 48h o alisante <span class="elsevierStyleItalic">no&#8208;lye</span> atingiu n&#237;veis maiores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL&#8208;1ra&#58; sempre maior com o <span class="elsevierStyleItalic">no&#8208;lye</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Os dois tipos tiveram raz&#245;es de IL&#8208;1ra&#47;IL&#8208;1&#945; similares nas fases iniciais &#40;sugere aus&#234;ncia de rela&#231;&#227;o com o desconforto imediato ap&#243;s a aplica&#231;&#227;o&#41; e tardias&#44; no entanto os <span class="elsevierStyleItalic">no&#8208;lye</span> tiveram uma raz&#227;o maior em 24h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#237;veis de PGE2 maiores do que os controles em todos os per&#237;odos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2878234.png"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Estudos sobre relaxantes capilares com avalia&#231;&#245;es morfol&#243;gicas e fisiol&#243;gicas</p>"
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        "etiqueta" => "Tabela 7"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at7"
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        "tabla" => array:1 [
          "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"><th 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" scope="col" style="border-bottom: 2px solid black">Autor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Formato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Alisante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Efeitos em haste&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">De S&#225; Dias et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">40</span></a> 2008</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensaio cl&#237;nico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amostras de cabelo afro</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tioglicolato de am&#244;nia</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">Agentes condicionantes adicionados ao alisante resultaram em menor perda proteica&#44; em prote&#231;&#227;o da fibra e em aumento da resist&#234;ncia &#224; quebra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Podem reduzir a efic&#225;cia do alisamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bernard et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">41</span></a> 2002&nbsp;\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">Ensaio cl&#237;nico&nbsp;\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">Amostras de cabelo afro&#8208;americano&nbsp;\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">Hidr&#243;xido de guanidina ou hidr&#243;xido de s&#243;dio&nbsp;\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">Uso de ceramidas &#40;no caso&#44; a C18&#8208;dhCer&#41; preveniu danos em cabelo alisado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vermeulen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">42</span></a> 2004&nbsp;\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">Ensaio cl&#237;nico&nbsp;\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">Amostras de cabelo&nbsp;\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">Hidr&#243;xido de s&#243;dio&#44; hidr&#243;xido de l&#237;tio&nbsp;\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">Adi&#231;&#227;o de ceras de polimetileno em f&#243;rmula alisante resultou em melhor aspecto em compara&#231;&#227;o a f&#243;rmulas comerciais&#44; sem minimizar a performance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Estudos sobre preven&#231;&#227;o de danos estruturais no uso de relaxantes capilares</p>"
        ]
      ]
      8 => array:8 [
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        "etiqueta" => "Tabela 8"
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        "detalles" => array:1 [
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">n&#44; n&#250;mero de pacientes&#59; F&#44; feminino&#59; M&#44; masculino&#46;</p>"
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            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"><th 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" scope="col" style="border-bottom: 2px solid black">Autor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Tipo de estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Agente alisante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Marks et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">43</span></a> 2019</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t">Caso&#8208;controle</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>286 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43 pacientes com alopecia cicatricial&#41;&#44; &#40;143 pacientes com alopecia n&#227;o cicatricial&#58; grupo controle&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t">Alisamento qu&#237;mico</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Maior frequ&#234;ncia de alisamento no grupo alopecia cicatricial &#40;25&#37;&#41; em rela&#231;&#227;o ao grupo controle &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hist&#243;ria pr&#233;via de alisamento em LPP&#47;AFF de 21&#37; e em 10&#37; dos controles pareados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ACCC&#58; mais exposi&#231;&#227;o cumulativa a alisantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Estudos sobre os efeitos dos alisantes &#225;cidos e alisantes tradicionais &#40;relaxantes capilares&#41;</p>"
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Article information
ISSN: 26662752
Original language: Portuguese
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