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Dilated Pore of Winer Clinical Presentation

  • Author: Alyssa Y Kim, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Feb 08, 2016
 

History

Most patients with dilated pore of Winer consult a dermatologist after many years of dealing with an unsightly, enlarged pore on the face.[4]

Patients with dilated pore of Winer usually have a past or present history of severe acne.

Patients report needing to repeatedly express a keratotic plug from the center of the dilated pore of Winer. The expression of this plug allows the further removal of caseous, white, soggy keratin from the deeper portion of the pore. Once the content of the dilated pore is expressed, a keratotic material similar to the original plug refills the pore within several weeks.

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Physical

A dilated pore of Winer usually appears as a solitary large comedo on the face, predominantly on the upper lip, cheek, or forehead. The lesion can also be found on the trunk, most commonly the back. A rare incidence involving external ear canal has also been reported.[5]

The skin surrounding the pore appears to be unchanged, with no inflammation or induration.

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Causes

The cause of a dilated pore of Winer is unknown. Winer suggested that an infection or an obstruction of the follicle ostium is the stimulus for the development of a dilated pore of Winer in a process similar to those of inflammatory cystic acne or other cystic conditions.

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Contributor Information and Disclosures
Author

Alyssa Y Kim, MD Clinical Associate Professor, Department of Dermatology, Keck School of Medicine of the University of Southern California

Alyssa Y Kim, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Sigma Xi, American College of Mohs Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Neil Shear, MD Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada

Neil Shear, MD is a member of the following medical societies: Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Dermatology Association, American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

Acknowledgements

Author would like to thank Dr Lawrence Marchtinger for his contribution of the microscopic slides.

References
  1. Winer LH. The dilated pore, a tricho-epithelioma. J Invest Dermatol. 1954 Sep. 23(3):181-8. [Medline].

  2. Steffen C. Winer's dilated pore: the infundibuloma. Am J Dermatopathol. 2001 Jun. 23(3):246-53. [Medline].

  3. Morikawa T, Takizawa H, Ohnishi T, Watanabe S. Dilated pore: a case report and an immunohistochemical study of cytokeratin expression. J Dermatol. 2003 Jul. 30(7):556-8. [Medline].

  4. Jakobiec FA, Bhat P, Sutula F. Winer's dilated pore of the eyelid. Ophthal Plast Reconstr Surg. 2009 Sep-Oct. 25(5):411-3. [Medline].

  5. Ayoub OM, Timms MS, Mene A. Winer's dilated pore, rare presentation in the external ear canal. Auris Nasus Larynx. 2001 Nov. 28(4):349-52. [Medline].

  6. Walsh SN, Cruz DJ, Hurt MA. Hair cortex comedo: a series of 34 cases. Am J Dermatopathol. 2010 Dec. 32(8):749-54. [Medline].

  7. Lee JY, Hirsch E. Pilar sheath acanthoma. Arch Dermatol. 1987 May. 123(5):569-70. [Medline].

  8. Moreira A, Menezes N, Guedes R, Tente D, Baptista A, Varela P. Dermoscopy of a dilated pore of Winer. Eur J Dermatol. 2010 Mar-Apr. 20(2):229. [Medline].

  9. Klovekorn G, Klovekorn W, Plewig G, Pinkus H. [Giant pore and hair-shaft acanthoma. Clinical and histologic diagnosis]. Hautarzt. 1983 May. 34(5):209-16. [Medline].

  10. Gonzalez-Guerra E, Requena L, Kutzner H. [Immunohistochemical study of calretinin in normal hair follicles and tumors with follicular differentiation]. Actas Dermosifiliogr. 2008 Jul-Aug. 99(6):456-63. [Medline].

  11. Carlson-Sweet KL, Weigand DA, MacFarlane DF. Trichoid basal cell carcinoma found in a dilated pore on the nose. Dermatol Surg. 2000 Sep. 26(9):874-6. [Medline].

  12. Burns T, Breathnach S, Cox N. Root's Textbook of Dermatology. 7th ed. Malden, Mass: Blackwell Science Ltd; 2004. 37.3.

  13. Champion RH, Burton JL, Burns DA, Breathnach S. Rook/Wilkinson/Ebling Textbook of Dermatology. 6th ed. Oxford, England: Blackwell Science; 1998. 1696.

  14. Elder D, Elenitsas R, Johnson Jr B. Lever's Histopathology of the Skin. 9th ed. Philadelphia, Pa: Lippincott Williams Wilkins; 2005. 871-872.

  15. Farmer ER, Hood AF. Pathology of the Skin. 2nd ed. New York, NY: McGraw-Hill; 2000. 1026-7.

 
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Hematoxylin and eosin stain. Original magnification X40. Courtesy of Lawrence Machtinger, MD.
Image shows an epidermal lining that is atrophic near the ostium but progressively hypertrophic and proliferative, with numerous rete ridges, in the deeper part of the cavity (hematoxylin and eosin, original magnification X100).
The cavity is filled with laminated keratin (hematoxylin and eosin, original magnification X100).
Dilated pore of Winer on forehead.
Dilated pores of Winer on forehead and lateral upper labial region.
Dilated pore of Winer on lateral upper labial region.
 
 
 
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