Dilated Pore of Winer

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Background

A dilated pore of Winer is a hair structure anomaly that appears as an enlarged solitary comedo.[1] Most commonly, it appears on the face of a middle-aged person. This condition is not associated with acne vulgaris. See the images below.


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Dilated pore of Winer on forehead.


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Dilated pores of Winer on forehead and lateral upper labial region.


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Dilated pore of Winer on lateral upper labial region.

Pathophysiology

A dilated pore of Winer is a tumor of the intraepidermal follicle and infundibulum of a pilosebaceous apparatus.[2] An immunohistochemical study using monoclonal antibodies against cytokeratins and involucrin confirmed differentiation toward the infundibulum and partly toward the isthmus.[3]

Epidemiology

Frequency

United States

Most cases of dilated pore of Winer 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.[4] 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 of dilated pore of Winer 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 of dilated pore of Winer 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.

History

Physical

Causes

Procedures

Dermoscopic findings

Dermoscopic examination shows a pinkish nodule with peripheral vessels in a regular pattern. The individual vessels at the periphery of the lesion extend towards the center. The size of the vessels decreases with every progressive branching. The center of the lesion reveals a dilated ostium filled with terminal hairs.[9]

Biopsy

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.[10] Gonzalez-Guerra et al reported in 2008 that cutaneous adnexal tumors of the hair follicle can be identified using immunohistochemistry studies for calretinin, with differentiation towards cells of the outer root sheath.[11]


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Hematoxylin and eosin stain. Original magnification X40. Courtesy of Lawrence Machtinger, MD.


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Image shows an epidermal lining that is atrophic near the ostium but progressively hypertrophic and proliferative, with numerous rete ridges, in the d....


View Image

The cavity is filled with laminated keratin (hematoxylin and eosin, original magnification X100).

Medical Care

Surgical Care

Consultations

Complications

Prognosis

Author

Alyssa Y Kim, MD,

Disclosure: Nothing to disclose.

Specialty Editors

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

Disclosure: Nothing to disclose.

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

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

Disclosure: Nothing to disclose.

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Disclosure: Abvie Honoraria Speaking and teaching

Chief Editor

Dirk M Elston, MD, Director, Ackerman Academy of Dermatopathology, New York

Disclosure: Nothing to disclose.

Additional Contributors

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. Sep 1954;23(3):181-8. [View Abstract]
  2. Steffen C. Winer's dilated pore: the infundibuloma. Am J Dermatopathol. Jun 2001;23(3):246-53. [View Abstract]
  3. 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. [View Abstract]
  4. 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. [View Abstract]
  5. Jakobiec FA, Bhat P, Sutula F. Winer's dilated pore of the eyelid. Ophthal Plast Reconstr Surg. Sep-Oct 2009;25(5):411-3. [View Abstract]
  6. 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. [View Abstract]
  7. Walsh SN, Cruz DJ, Hurt MA. Hair cortex comedo: a series of 34 cases. Am J Dermatopathol. Dec 2010;32(8):749-54. [View Abstract]
  8. Lee JY, Hirsch E. Pilar sheath acanthoma. Arch Dermatol. May 1987;123(5):569-70. [View Abstract]
  9. Moreira A, Menezes N, Guedes R, Tente D, Baptista A, Varela P. Dermoscopy of a dilated pore of Winer. Eur J Dermatol. Mar-Apr 2010;20(2):229. [View Abstract]
  10. 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. [View Abstract]
  11. Gonzalez-Guerra E, Requena L, Kutzner H. [Immunohistochemical study of calretinin in normal hair follicles and tumors with follicular differentiation]. Actas Dermosifiliogr. Jul-Aug 2008;99(6):456-63. [View Abstract]
  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.
  16. 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. [View Abstract]
  17. Mehregan AH, Brownstein MH. Pilar sheath acanthoma. Arch Dermatol. Oct 1978;114(10):1495-7. [View Abstract]
  18. 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. [View Abstract]

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.

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).

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.