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contratura dos dedos poupando o polegar e atrofia dos m&#250;sculos tenar e hipotenar&#46; Ele negava sintomas&#44; hist&#243;ria de trauma e n&#227;o havia notado essa deformidade &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">O segundo caso era paciente do sexo feminino de 54 anos com diagn&#243;stico de ros&#225;cea&#44; que veio &#224; consulta em raz&#227;o de uma crise recente&#46; Como achado coincidente&#44; foi observada a deformidade de UBP no quinto quirod&#225;ctilo esquerdo&#46; Ela apresentava hist&#243;ria de trauma com faca na m&#227;o esquerda aos 8 anos de idade &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">O terceiro paciente era um homem de 80 anos com hist&#243;rico pessoal de hipertens&#227;o&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> e doen&#231;a cerebrovascular&#44; hospitalizado por dist&#250;rbio da marcha&#46; Durante sua avalia&#231;&#227;o&#44; foi observado que o primeiro e o segundo quirod&#225;ctilos direitos tinham sido parcialmente amputados e a unha do terceiro quirod&#225;ctilo apresentava deformidade tipo UBP&#46; Ele afirmou que essas mudan&#231;as foram causadas pela explos&#227;o de fogos de artif&#237;cio caseiros aos 13 anos de idade &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Kandil foi o primeiro a descrever essa deformidade em 1971&#44; nomeando&#8208;a em decorr&#234;ncia de sua semelhan&#231;a com o bico de um papagaio&#46; Ele relatou supercurvatura idiop&#225;tica de duas unhas em uma paciente de 38 anos&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Chen e Cohen relataram a preval&#234;ncia de 2&#44;1&#37; em 436 pacientes que consultaram uma cl&#237;nica de dermatologia&#46; Marie et al&#46; observaram essa condi&#231;&#227;o em 2&#44;5&#37; de 80 indiv&#237;duos saud&#225;veis&#46; Outras s&#233;ries de casos mostraram que 31&#37; dos pacientes com esclerose sist&#234;mica podem apresentar essa distrofia ungueal&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a> Essa deformidade foi encontrada em pacientes de 11 a 89 anos&#44; sem predomin&#226;ncia de sexo&#46; Foram encontrados nove artigos relatando esse achado cl&#237;nico&#44; com um total de 78 pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Sua etiologia permanece desconhecida&#46; A UBP tem sido associada a diversas condi&#231;&#245;es&#44; incluindo doen&#231;as vasculares do col&#225;geno&#44; como l&#250;pus eritematoso sist&#234;mico e esclerose sist&#234;mica&#44; onde pode ser o primeiro achado e tem sido relacionada &#224; atividade da doen&#231;a&#46; Associa&#231;&#245;es adicionais incluem abuso de coca&#237;na&#44; trauma&#44; entre outras condi&#231;&#245;es&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;5</span></a> A teoria mais aceita prop&#245;e que seja o resultado de uma distribui&#231;&#227;o anormal de fosfolip&#237;dios&#44; que causa intera&#231;&#245;es hidrof&#243;bicas entre diferentes zonas da l&#226;mina ungueal&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Autores que apoiam essa teoria afirmam que a curvatura excessiva vista na UBP pode ser corrigida temporariamente ap&#243;s submergir a unha afetada em &#225;gua por alguns minutos&#44; uma vez que isso superaria essas intera&#231;&#245;es hidrof&#243;bicas&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Uma les&#227;o pr&#233;via pode ser a causa principal&#44; como no segundo e terceiro casos aqui descritos&#46; Isso geraria um desequil&#237;brio cr&#244;nico de crescimento e alteraria o conte&#250;do de fosfolip&#237;dios hidrof&#243;bicos&#44; levando a uma pronunciada curvatura longitudinal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Outras teorias incluem isquemia vasoconstritora cr&#244;nica como fator chave&#44; com base em uma s&#233;rie de casos de oito mulheres com abuso cr&#244;nico de coca&#237;na que desenvolveram essa deformidade&#59;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> al&#233;m disso&#44; a UBP &#233; comum em pacientes com esclerose sist&#234;mica&#44; em que tem sido associada &#224; atividade vascular&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> Tamb&#233;m pode ser secund&#225;ria a altera&#231;&#245;es &#243;sseas ou de tecidos moles&#44; que podem ser cong&#234;nitas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O trauma repetido &#233;&#44; em certos casos&#44; a causa principal&#46; A distrofia da UBP &#233; encontrada em pacientes com neuropatia perif&#233;rica propensos a traumatismos despercebidos do leito ungueal&#46; A amputa&#231;&#227;o digital e o fechamento cir&#250;rgico na cirurgia da ponta do dedo s&#227;o causas de atrofia pulpar e cicatrizes extensas&#44; que podem levar a deformidade em gancho da unha que se assemelha &#224; UBP&#46; Algumas t&#233;cnicas cir&#250;rgicas foram descritas para sua preven&#231;&#227;o&#58; realoca&#231;&#227;o da unha&#44; agulhas hipod&#233;rmicas para fechamento sem tens&#227;o&#44; entre outras&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Quando associada ao abuso cr&#244;nico de coca&#237;na&#44; foi relatada uma tr&#237;ade consistindo em UBP&#44; perniose e atrofia da polpa do quirod&#225;ctilo&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Outras comorbidades citadas na literatura&#44; sejam achados coincidentes associados ou n&#227;o&#44; incluem distrofia &#243;ssea&#44; doen&#231;a arterial coronariana&#44; pancreatite esclerosante linfoplasmocit&#225;ria&#44; atrofia de m&#250;ltiplos sistemas&#44; deformidade digital &#40;dedo em martelo&#44; quinto dedo sobrejacente&#41; e hipoplasia de partes moles&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Os casos associados &#224; neuropatia relatados anteriormente incluem um relato de caso de Forouzan et al&#46;&#44; que descreveram um paciente que desconhecia o alongamento da unha do podod&#225;ctilo&#44; em decorr&#234;ncia de uma neuropatia perif&#233;rica induzida pela terapia de priva&#231;&#227;o androg&#234;nica&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Outros casos associados a neuropatia descritos por Chen et al&#46; incluem indiv&#237;duos com diabetes <span class="elsevierStyleItalic">mellitus</span> e neuropatia induzida por estenose espinhal&#46; O primeiro paciente descrito aqui tinha neuropatia hans&#234;nica&#44; associa&#231;&#227;o n&#227;o descrita at&#233; a data que foi pesquisada a literatura&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Clinicamente&#44; a UBP pode afetar uma ou v&#225;rias unhas das m&#227;os ou dos p&#233;s&#59; entretanto&#44; &#233; mais comum nas unhas das m&#227;os&#46; Quando as unhas dos p&#233;s s&#227;o afetadas&#44; geralmente h&#225; associa&#231;&#227;o com anormalidades cong&#234;nitas&#44; neuropatias ou condi&#231;&#245;es sist&#234;micas&#46; Por outro lado&#44; em indiv&#237;duos com envolvimento das unhas das m&#227;os&#44; a maioria dos casos &#233; idiop&#225;tica&#46; Outros componentes do aparelho ungueal&#44; como l&#226;mina ungueal proximal&#44; leito ungueal&#44; matriz ungueal e tecidos moles&#44; permanecem sem altera&#231;&#245;es&#59; no entanto&#44; a UBP pode coexistir com outras distrofias ungueais&#44; como onicocriptose&#44; onicogrifose&#44; onic&#243;lise&#44; eritron&#237;quia&#44; hemorragia subungueal e onicotilomania&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Em geral&#44; essa deformidade &#233; assintom&#225;tica e&#44; portanto&#44; sub&#8208;relatada&#59; mas se a unha deformada crescer em dire&#231;&#227;o &#224;s superf&#237;cies palmar ou plantar&#44; pode lesar a pele dessas regi&#245;es&#44; com risco de superinfec&#231;&#227;o&#46; O diagn&#243;stico &#233; cl&#237;nico&#44; e uma ajuda semiol&#243;gica consiste em mergulhar a unha em &#225;gua por 30 minutos&#44; o que corrigiria temporariamente a deformidade&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Entre os diagn&#243;sticos diferenciais&#44; pode&#8208;se distinguir entre baqueteamento e UBP&#44; pela curvatura normal da l&#226;mina ungueal no primeiro&#46; Pacientes com paquion&#237;quia cong&#234;nita podem apresentar unhas curvas&#44; mas tamb&#233;m s&#227;o grossas e marrons ou amareladas&#46; A onicogrifose &#233; causada principalmente por sapatos mal ajustados&#46; Outros dist&#250;rbios&#44; como a curvatura cong&#234;nita da unha do quarto podod&#225;ctilo&#44; tamb&#233;m podem se assemelhar &#224; UBP&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">O corte peri&#243;dico das unhas deve ser recomendado para evitar o crescimento cont&#237;nuo&#46; A UBP pode ser curada com onicectomia e matricectomia&#44; o que pode beneficiar pacientes com casos sintom&#225;ticos ou recorrentes&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0080" class="elsevierStylePara elsevierViewall">Camilo Arias&#8208;Rodriguez e Santiago Beuth&#8208;Ruiz contribu&#237;ram com a concep&#231;&#227;o e planejamento do estudo&#44; obten&#231;&#227;o de dados&#44; reda&#231;&#227;o e aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0090" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Arias&#8208;Rodriguez C&#44; Beuth&#8208;Ruiz S&#46; Parrot beak nails&#58; a Latin American case series&#46; An Bras Dermatol&#46; 2023&#59;98&#58;96&#8211;9&#46;</p>"
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Unha do primeiro quirod&#225;ctilo da m&#227;o esquerda mostrando deformidade tipo UBP&#46; &#40;B&#41; Todas as unhas eram afetadas&#44; com contratura associada de todos os quirod&#225;ctilos e atrofia dos m&#250;sculos da m&#227;o&#46; A segunda unha mostra espessamento focal da l&#226;mina ungueal e cromon&#237;quia marrom&#44; a terceira unha mostra onic&#243;lise e cromon&#237;quia amarela&#44; e observa&#8208;se melanon&#237;quia longitudinal da terceira e quarta unhas&#46;</p>"
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          "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Deformidade tipo UBP da unha do quinto quirod&#225;ctilo esquerdo&#46; &#40;B&#41; A dermatoscopia melhor observa&#231;&#227;o da caracter&#237;stica curvatura da l&#226;mina ungueal&#46;</p>"
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          "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Deformidade tipo UBP secund&#225;ria a trauma da unha do segundo quirod&#225;ctilo&#44; com atrofia pulpar associada&#46;</p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">As refer&#234;ncias desses artigos podem ser encontradas em <a class="elsevierStyleCrossRef" href="#sec0070">Ap&#234;ndice</a>&#46;</p>"
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                  <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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&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">Ano&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">Idade&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">Sexo&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">Unha afetada&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">Associa&#231;&#245;es ungueais&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">Associa&#231;&#245;es sist&#234;micas&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-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">Kandil&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">1&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">1971&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">38&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">Feminino&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">Unhas do terceiro e quarto dedos das m&#227;os&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">Nenhuma&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">Idiop&#225;tica&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">Kurokawa et al&#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">2&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">1993&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">11&#44; 17&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">Feminino&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">Podod&#225;ctilos&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">Nenhuma&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">Anormalidades cong&#234;nitas dos tecidos moles e hipoplasia &#243;ssea&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">Payne&#8208;James et al&#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">8&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">2007&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">24 a 40&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">Feminino&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">Quirod&#225;ctilos&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">Perniose&#44; aumento das dobras ungueais proximais e perda de cut&#237;culas&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">Abuso cr&#244;nico de coca&#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">Tunc et al&#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">11&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">2007&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">40 a 68&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">Desconhecido&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&#227;o declarado&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">Nenhuma&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">Artrite reumatoide e esclerose sist&#234;mica&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">Desai et al&#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">1&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">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">55&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">Feminino&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">Unhas dos quirod&#225;ctilos&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">Nenhuma&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">Idiop&#225;tica&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">Chang et al&#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">2&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">2016&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&#227;o declarado&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">Masculino e feminino&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&#227;o declarado&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">Nenhuma&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">Esclerose sist&#234;mica e doen&#231;a mista do tecido conjuntivo&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">Marie et al&#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">42&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">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">N&#227;o declarado&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">Desconhecido&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">Unhas dos quirod&#225;ctilos&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">Nenhuma&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">Idiop&#225;tica&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">Chen et al&#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">10&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">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">63 a 89&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">Masculino&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">Unhas dos podod&#225;ctilos&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">Onic&#243;lise&#44; hemorragia subungueal&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">Altera&#231;&#245;es sist&#234;micas idiop&#225;ticas&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">Forouzan et al&#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">1&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">2021&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">86&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">Masculino&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">Unha do quarto podod&#225;ctilo&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">Onic&#243;lise distal&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">Doen&#231;a pulmonar&#44; dem&#234;ncia&#44; hipotireoidismo&#44; c&#226;ncer de pr&#243;stata e c&#226;ncer de pele n&#227;o&#8208;melanoma&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">Arias&#8208;Rodriguez et al&#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">3&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">2022&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">54&#44; 75&#44; 80&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">Masculino e feminino&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">Unhas dos quirod&#225;ctilos&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">Nenhuma&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">Hansen&#237;ase e trauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Parrot Beak Nails Revisited&#58; Case Series and Comprehensive Review"
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                      "titulo" => "Parrot Beak Nail&#58; Case Report and Review of Parrot Beak Nail Dystrophy"
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                      "doi" => "10.7759/cureus.15974"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34336466"
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                            0 => "I&#46; Marie"
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                            2 => "K&#46; Nassermadji"
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                      "doi" => "10.1016/j.jaad.2016.11.024"
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                            2 => "T&#46; Pirildar"
                            3 => "T&#46; Turk"
                            4 => "M&#46; Ozturk"
                            5 => "E&#46; Doganavsargil"
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Carta ‐ Investigação
Unhas em “bico de papagaio”: série de casos latino‐americanos
Camilo Arias‐Rodrigueza, Santiago Beuth‐Ruizb,
Corresponding author
santiago.beuthr@udea.edu.co

Autor para correspondência.
a Universidad Pontificia Bolivariana, Medellín, Colômbia
b Universidad de Antioquia, Medellín, Colômbia
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          "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Deformidade tipo UBP da unha do quinto quirod&#225;ctilo esquerdo&#46; &#40;B&#41; A dermatoscopia melhor observa&#231;&#227;o da caracter&#237;stica curvatura da l&#226;mina ungueal&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A deformidade da unha em &#8220;bico de papagaio&#8221; &#40;UBP&#41; consiste em curvatura para frente da l&#226;mina ungueal distal&#44; o que confere &#224; unha a apar&#234;ncia do bico da ave&#46; Aqui&#44; os autores apresentam tr&#234;s casos de distrofia por deformidade tipo UBP&#44; descrevem uma nova associa&#231;&#227;o e fazem uma breve revis&#227;o da literatura&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">O primeiro caso era paciente do sexo masculino de 75 anos&#44; com hist&#243;rico m&#233;dico de hansen&#237;ase diagnosticada havia 20 anos&#44; que recebeu tratamento completo&#44; e procurou a cl&#237;nica dermatol&#243;gica em raz&#227;o de uma dermatite de estase&#46; Ao exame f&#237;sico&#44; por coincid&#234;ncia&#44; foram encontradas v&#225;rias e importantes sequelas&#46; Apresentava UBP em todas as unhas&#44; cromon&#237;quia e onic&#243;lise em diversas unhas&#44; contratura dos dedos poupando o polegar e atrofia dos m&#250;sculos tenar e hipotenar&#46; Ele negava sintomas&#44; hist&#243;ria de trauma e n&#227;o havia notado essa deformidade &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">O segundo caso era paciente do sexo feminino de 54 anos com diagn&#243;stico de ros&#225;cea&#44; que veio &#224; consulta em raz&#227;o de uma crise recente&#46; Como achado coincidente&#44; foi observada a deformidade de UBP no quinto quirod&#225;ctilo esquerdo&#46; Ela apresentava hist&#243;ria de trauma com faca na m&#227;o esquerda aos 8 anos de idade &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">O terceiro paciente era um homem de 80 anos com hist&#243;rico pessoal de hipertens&#227;o&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> e doen&#231;a cerebrovascular&#44; hospitalizado por dist&#250;rbio da marcha&#46; Durante sua avalia&#231;&#227;o&#44; foi observado que o primeiro e o segundo quirod&#225;ctilos direitos tinham sido parcialmente amputados e a unha do terceiro quirod&#225;ctilo apresentava deformidade tipo UBP&#46; Ele afirmou que essas mudan&#231;as foram causadas pela explos&#227;o de fogos de artif&#237;cio caseiros aos 13 anos de idade &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Kandil foi o primeiro a descrever essa deformidade em 1971&#44; nomeando&#8208;a em decorr&#234;ncia de sua semelhan&#231;a com o bico de um papagaio&#46; Ele relatou supercurvatura idiop&#225;tica de duas unhas em uma paciente de 38 anos&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Chen e Cohen relataram a preval&#234;ncia de 2&#44;1&#37; em 436 pacientes que consultaram uma cl&#237;nica de dermatologia&#46; Marie et al&#46; observaram essa condi&#231;&#227;o em 2&#44;5&#37; de 80 indiv&#237;duos saud&#225;veis&#46; Outras s&#233;ries de casos mostraram que 31&#37; dos pacientes com esclerose sist&#234;mica podem apresentar essa distrofia ungueal&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a> Essa deformidade foi encontrada em pacientes de 11 a 89 anos&#44; sem predomin&#226;ncia de sexo&#46; Foram encontrados nove artigos relatando esse achado cl&#237;nico&#44; com um total de 78 pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Sua etiologia permanece desconhecida&#46; A UBP tem sido associada a diversas condi&#231;&#245;es&#44; incluindo doen&#231;as vasculares do col&#225;geno&#44; como l&#250;pus eritematoso sist&#234;mico e esclerose sist&#234;mica&#44; onde pode ser o primeiro achado e tem sido relacionada &#224; atividade da doen&#231;a&#46; Associa&#231;&#245;es adicionais incluem abuso de coca&#237;na&#44; trauma&#44; entre outras condi&#231;&#245;es&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;5</span></a> A teoria mais aceita prop&#245;e que seja o resultado de uma distribui&#231;&#227;o anormal de fosfolip&#237;dios&#44; que causa intera&#231;&#245;es hidrof&#243;bicas entre diferentes zonas da l&#226;mina ungueal&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Autores que apoiam essa teoria afirmam que a curvatura excessiva vista na UBP pode ser corrigida temporariamente ap&#243;s submergir a unha afetada em &#225;gua por alguns minutos&#44; uma vez que isso superaria essas intera&#231;&#245;es hidrof&#243;bicas&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Uma les&#227;o pr&#233;via pode ser a causa principal&#44; como no segundo e terceiro casos aqui descritos&#46; Isso geraria um desequil&#237;brio cr&#244;nico de crescimento e alteraria o conte&#250;do de fosfolip&#237;dios hidrof&#243;bicos&#44; levando a uma pronunciada curvatura longitudinal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Outras teorias incluem isquemia vasoconstritora cr&#244;nica como fator chave&#44; com base em uma s&#233;rie de casos de oito mulheres com abuso cr&#244;nico de coca&#237;na que desenvolveram essa deformidade&#59;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> al&#233;m disso&#44; a UBP &#233; comum em pacientes com esclerose sist&#234;mica&#44; em que tem sido associada &#224; atividade vascular&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> Tamb&#233;m pode ser secund&#225;ria a altera&#231;&#245;es &#243;sseas ou de tecidos moles&#44; que podem ser cong&#234;nitas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O trauma repetido &#233;&#44; em certos casos&#44; a causa principal&#46; A distrofia da UBP &#233; encontrada em pacientes com neuropatia perif&#233;rica propensos a traumatismos despercebidos do leito ungueal&#46; A amputa&#231;&#227;o digital e o fechamento cir&#250;rgico na cirurgia da ponta do dedo s&#227;o causas de atrofia pulpar e cicatrizes extensas&#44; que podem levar a deformidade em gancho da unha que se assemelha &#224; UBP&#46; Algumas t&#233;cnicas cir&#250;rgicas foram descritas para sua preven&#231;&#227;o&#58; realoca&#231;&#227;o da unha&#44; agulhas hipod&#233;rmicas para fechamento sem tens&#227;o&#44; entre outras&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Quando associada ao abuso cr&#244;nico de coca&#237;na&#44; foi relatada uma tr&#237;ade consistindo em UBP&#44; perniose e atrofia da polpa do quirod&#225;ctilo&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Outras comorbidades citadas na literatura&#44; sejam achados coincidentes associados ou n&#227;o&#44; incluem distrofia &#243;ssea&#44; doen&#231;a arterial coronariana&#44; pancreatite esclerosante linfoplasmocit&#225;ria&#44; atrofia de m&#250;ltiplos sistemas&#44; deformidade digital &#40;dedo em martelo&#44; quinto dedo sobrejacente&#41; e hipoplasia de partes moles&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Os casos associados &#224; neuropatia relatados anteriormente incluem um relato de caso de Forouzan et al&#46;&#44; que descreveram um paciente que desconhecia o alongamento da unha do podod&#225;ctilo&#44; em decorr&#234;ncia de uma neuropatia perif&#233;rica induzida pela terapia de priva&#231;&#227;o androg&#234;nica&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Outros casos associados a neuropatia descritos por Chen et al&#46; incluem indiv&#237;duos com diabetes <span class="elsevierStyleItalic">mellitus</span> e neuropatia induzida por estenose espinhal&#46; O primeiro paciente descrito aqui tinha neuropatia hans&#234;nica&#44; associa&#231;&#227;o n&#227;o descrita at&#233; a data que foi pesquisada a literatura&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Clinicamente&#44; a UBP pode afetar uma ou v&#225;rias unhas das m&#227;os ou dos p&#233;s&#59; entretanto&#44; &#233; mais comum nas unhas das m&#227;os&#46; Quando as unhas dos p&#233;s s&#227;o afetadas&#44; geralmente h&#225; associa&#231;&#227;o com anormalidades cong&#234;nitas&#44; neuropatias ou condi&#231;&#245;es sist&#234;micas&#46; Por outro lado&#44; em indiv&#237;duos com envolvimento das unhas das m&#227;os&#44; a maioria dos casos &#233; idiop&#225;tica&#46; Outros componentes do aparelho ungueal&#44; como l&#226;mina ungueal proximal&#44; leito ungueal&#44; matriz ungueal e tecidos moles&#44; permanecem sem altera&#231;&#245;es&#59; no entanto&#44; a UBP pode coexistir com outras distrofias ungueais&#44; como onicocriptose&#44; onicogrifose&#44; onic&#243;lise&#44; eritron&#237;quia&#44; hemorragia subungueal e onicotilomania&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Em geral&#44; essa deformidade &#233; assintom&#225;tica e&#44; portanto&#44; sub&#8208;relatada&#59; mas se a unha deformada crescer em dire&#231;&#227;o &#224;s superf&#237;cies palmar ou plantar&#44; pode lesar a pele dessas regi&#245;es&#44; com risco de superinfec&#231;&#227;o&#46; O diagn&#243;stico &#233; cl&#237;nico&#44; e uma ajuda semiol&#243;gica consiste em mergulhar a unha em &#225;gua por 30 minutos&#44; o que corrigiria temporariamente a deformidade&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Entre os diagn&#243;sticos diferenciais&#44; pode&#8208;se distinguir entre baqueteamento e UBP&#44; pela curvatura normal da l&#226;mina ungueal no primeiro&#46; Pacientes com paquion&#237;quia cong&#234;nita podem apresentar unhas curvas&#44; mas tamb&#233;m s&#227;o grossas e marrons ou amareladas&#46; A onicogrifose &#233; causada principalmente por sapatos mal ajustados&#46; Outros dist&#250;rbios&#44; como a curvatura cong&#234;nita da unha do quarto podod&#225;ctilo&#44; tamb&#233;m podem se assemelhar &#224; UBP&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">O corte peri&#243;dico das unhas deve ser recomendado para evitar o crescimento cont&#237;nuo&#46; A UBP pode ser curada com onicectomia e matricectomia&#44; o que pode beneficiar pacientes com casos sintom&#225;ticos ou recorrentes&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0080" class="elsevierStylePara elsevierViewall">Camilo Arias&#8208;Rodriguez e Santiago Beuth&#8208;Ruiz contribu&#237;ram com a concep&#231;&#227;o e planejamento do estudo&#44; obten&#231;&#227;o de dados&#44; reda&#231;&#227;o e aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0090" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Arias&#8208;Rodriguez C&#44; Beuth&#8208;Ruiz S&#46; Parrot beak nails&#58; a Latin American case series&#46; An Bras Dermatol&#46; 2023&#59;98&#58;96&#8211;9&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado na Cl&#237;nica Universitaria Bolivariana&#44; Universidad Pontificia Bolivariana&#44; e Hospital Alma M&#225;ter de Antioquia&#44; Medell&#237;n&#44; Col&#244;mbia&#46;</p>"
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          "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Deformidade tipo UBP da unha do quinto quirod&#225;ctilo esquerdo&#46; &#40;B&#41; A dermatoscopia melhor observa&#231;&#227;o da caracter&#237;stica curvatura da l&#226;mina ungueal&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unhas do terceiro e quarto dedos das m&#227;os&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">Nenhuma&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">Idiop&#225;tica&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">Kurokawa et al&#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">2&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">1993&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">11&#44; 17&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">Feminino&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">Podod&#225;ctilos&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">Nenhuma&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">Anormalidades cong&#234;nitas dos tecidos moles e hipoplasia &#243;ssea&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">Payne&#8208;James et al&#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">8&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">2007&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">24 a 40&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">Feminino&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">Quirod&#225;ctilos&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">Perniose&#44; aumento das dobras ungueais proximais e perda de cut&#237;culas&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">Abuso cr&#244;nico de coca&#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">Tunc et al&#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">11&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">2007&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">40 a 68&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">Desconhecido&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&#227;o declarado&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">Nenhuma&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">Artrite reumatoide e esclerose sist&#234;mica&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">Desai et al&#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">1&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">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">55&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">Feminino&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">Unhas dos quirod&#225;ctilos&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">Nenhuma&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">Idiop&#225;tica&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">Chang et al&#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">2&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">2016&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&#227;o declarado&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">Masculino e feminino&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&#227;o declarado&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">Nenhuma&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">Esclerose sist&#234;mica e doen&#231;a mista do tecido conjuntivo&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">Marie et al&#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">42&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">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">N&#227;o declarado&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">Desconhecido&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">Unhas dos quirod&#225;ctilos&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">Nenhuma&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">Idiop&#225;tica&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">Chen et al&#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">10&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">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">63 a 89&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">Masculino&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">Unhas dos podod&#225;ctilos&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">Onic&#243;lise&#44; hemorragia subungueal&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">Altera&#231;&#245;es sist&#234;micas idiop&#225;ticas&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">Forouzan et al&#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">1&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">2021&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">86&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">Masculino&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">Unha do quarto podod&#225;ctilo&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">Onic&#243;lise distal&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">Doen&#231;a pulmonar&#44; dem&#234;ncia&#44; hipotireoidismo&#44; c&#226;ncer de pr&#243;stata e c&#226;ncer de pele n&#227;o&#8208;melanoma&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">Arias&#8208;Rodriguez et al&#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">3&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">2022&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">54&#44; 75&#44; 80&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">Masculino e feminino&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
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                  \t\t\t\t">Unhas dos quirod&#225;ctilos&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
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                  \t\t\t\t">Nenhuma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hansen&#237;ase e trauma&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 26662752
Original language: Portuguese
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