Continually Updated Clinical Reference
 
 
  All Sources     eMedicine     Medscape     Drug Reference     MEDLINE
 
eMedicine - Dilated Pore of Winer : Article by

Quick Find
Authors & Editors
Introduction
Clinical
Differentials
Workup
Treatment
Follow-up
Miscellaneous
Multimedia
References

Related Articles
Epidermal Inclusion Cyst

Favre-Racouchot Syndrome (Nodular Elastosis with Cysts and Comedones)

Pilar Cyst

Trichoepithelioma




Patient Education
Click here for patient education.


AUTHOR AND EDITOR INFORMATION

Section 1 of 10 Click here to go to the next section in this topic  

Author: Y Alyssa Kim, MD, Clinical Assistant Professor, Department of Dermatology, University of Southern California School of Medicine

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

Editors: Neil Shear, MD, Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Medical School; Head of Dermatology, Sunnybrook Women's College Health Sciences Center, Canada; Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center; Jeffrey J Miller, MD, Associate Professor, Department of Dermatology, Penn State University, Milton S Hershey Medical Center; Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital; Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center

Author and Editor Disclosure

Synonyms and related keywords: Winer's pore, Winer's dilated pore, dilated pore, giant follicle, enlarged solitary comedo, intraepidermal follicle, pilosebaceous apparatus

INTRODUCTION

Section 2 of 10 Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic  

Background

A dilated pore of Winer is a hair structure anomaly that appears as an enlarged solitary comedo. Most commonly, it appears on the face of a middle-aged person. This condition is not associated with acne vulgaris.

Pathophysiology

A dilated pore of Winer is a tumor of the intraepidermal follicle and infundibulum of a pilosebaceous apparatus. An immunohistochemical study using monoclonal antibodies against cytokeratins and involucrin confirmed differentiation toward the infundibulum and partly toward the isthmus.

Frequency

United States

Most cases are reported in older adults in both the American and European literature.

Mortality/Morbidity

Death is not associated with a dilated pore of Winer. One case of trichoid basal cell carcinoma in a dilated pore has been reported. More commonly, chronic manipulation and expression of the keratotic plug from inside the pore may lead to inflammation and infection of the surrounding tissue.

Race

Most cases have been reported in white males.

Sex

Although dilated pores are found in both sexes, they appear to occur in men more often than in women.

Age

Most cases are diagnosed in individuals older than 40 years; however, many individuals report that they have had the lesions for many decades, usually starting when they are aged 20-60 years.


CLINICAL

Section 3 of 10 Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic  

History

  • Most patients consult a dermatologist after many years of dealing with an unsightly, enlarged pore on the face.

  • Patients usually have a past or present history of severe acne.

  • Patients report needing to repeatedly express a keratotic plug from the pore center.
    • 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.

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.

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

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.


DIFFERENTIALS

Section 4 of 10 Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic  

Epidermal Inclusion Cyst
Favre-Racouchot Syndrome (Nodular Elastosis with Cysts and Comedones)
Pilar Cyst
Trichoepithelioma

Other Problems to be Considered

Pilar sheath acanthoma
Sebaceous trichofolliculoma


WORKUP

Section 5 of 10 Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic  

Procedures

  • Histologic examination of a biopsy specimen from the lesion is the only way to make a definitive diagnosis.

Histologic Findings

A dilated follicular infundibulum extends deep into the dermis and, at times, into the subcutaneous tissue. The cavity is lined by the epidermis, which is atrophic near the follicular ostium. The epidermis is hypertrophic and proliferative in the deeper portion of the invagination where the numerous rete ridges project into the surrounding stroma. The cavity is filled with laminated keratin. Vellus hair follicles and small sebaceous lobules may be attached to the lower portion of the infundibulum.


TREATMENT

Section 6 of 10 Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic  

Medical Care

No medical treatment is available for a dilated pore of Winer.

Surgical Care

  • Excision of the entire lesion and closure of the resulting surgical defect are curative.

  • Superficial treatments, such as electrodesiccation, cauterization, coagulation, dermabrasion, or carbon dioxide laser surgery, are less effective because of the deeply invaginated base of a dilated pore of Winer.

Consultations

A dermatopathologist may be consulted.


FOLLOW-UP

Section 7 of 10 Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic  

Complications

  • Manipulation of the lesion may lead to infection and scarring.

Prognosis

  • Incomplete excision results in regeneration of the dilated pore from the residual infundibular lining.

  • Prognosis is excellent with no known report of death.


MISCELLANEOUS

Section 8 of 10 Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic  

Medical/Legal Pitfalls

  • A possible serendipitous neoplastic process needs to be addressed, especially on sun-damaged areas on a patient's body.


MULTIMEDIA

Section 9 of 10 Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic  

Media file 1:  Hematoxylin and eosin stain. Original magnification X40. Courtesy of Lawrence Machtinger, MD.
Click to see larger pictureClick to see detailView Full Size Image
Media type:  Photo

Media file 2:  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).
Click to see larger pictureClick to see detailView Full Size Image
Media type:  Photo

Media file 3:  The cavity is filled with laminated keratin (hematoxylin and eosin, original magnification X100).
Click to see larger pictureClick to see detailView Full Size Image
Media type:  Photo

Media file 4:  Dilated pore of Winer on forehead.
Click to see larger pictureClick to see detailView Full Size Image
Media type:  Photo


REFERENCES

Section 10 of 10 Click here to go to the previous section in this topic Click here to go to the top of this page

  • Ayoub OM, Timms MS, Mene A. Winer's dilated pore, rare presentation in the external ear canal. Auris Nasus Larynx. Nov 2001;28(4):349-52. [Medline].
  • Burns T, Breathnach S, Cox N. Root's Textbook of Dermatology. 7th ed. Malden, Mass: Blackwell Science Ltd; 2004:37.3.
  • Carlson-Sweet KL, Weigand DA, MacFarlane DF. Trichoid basal cell carcinoma found in a dilated pore on the nose. Dermatol Surg. Sep 2000;26(9):874-6. [Medline].
  • Elder D, Elenitsas R, Johnson Jr B. Lever's Histopathology of the Skin. 9th ed. Philadelphia, Pa: Lippincott Williams Wilkins; 2005:871-872.
  • Farmer ER, Hood AF. Pathology of the Skin. 2nd ed. New York, NY: McGraw-Hill; 2000:1026-7.
  • Klovekorn G, Klovekorn W, Plewig G, Pinkus H. [Giant pore and hair-shaft acanthoma. Clinical and histologic diagnosis]. Hautarzt. May 1983;34(5):209-16. [Medline].
  • Lee JY, Hirsch E. Pilar sheath acanthoma. Arch Dermatol. May 1987;123(5):569-70. [Medline].
  • Luther PB, Scott DW, Buerger RG. The dilated pore of Winer--an overlooked cutaneous lesion of cats. J Comp Pathol. Nov 1989;101(4):375-9. [Medline].
  • Mehregan AH, Brownstein MH. Pilar sheath acanthoma. Arch Dermatol. Oct 1978;114(10):1495-7. [Medline].
  • Morikawa T, Takizawa H, Ohnishi T, Watanabe S. Dilated pore: a case report and an immunohistochemical study of cytokeratin expression. J Dermatol. Jul 2003;30(7):556-8. [Medline].
  • Resnik KS, Kantor GR, Howe NR, Ditre CM. Dilated pore nevus. A histologic variant of nevus comedonicus. Am J Dermatopathol. Apr 1993;15(2):169-71. [Medline].
  • Champion RH, Burton JL, Burns DA, Breathnach S. Rook/Wilkinson/Ebling Textbook of Dermatology. 6th ed. Oxford, England: Blackwell Science; 1998:1696.
  • Steffen C. Winer's dilated pore: the infundibuloma. Am J Dermatopathol. Jun 2001;23(3):246-53. [Medline].
  • Winer LH. The dilated pore, a tricho-epithelioma. J Invest Dermatol. Sep 1954;23(3):181-8. [Medline].

Dilated Pore of Winer excerpt

Article Last Updated: Jan 24, 2007