A Dilated Pore of Winer (DPOW) is a distinct, benign skin lesion often mistaken for an unusually large blackhead. First described in 1954 by Louis H. Winer, this follicular tumor poses no serious health risk but can cause cosmetic concern. Its size and internal structure prevent successful removal by standard at-home extraction methods.
The Core Identity: What Defines a Dilated Pore of Winer?
The Dilated Pore of Winer is fundamentally a greatly enlarged, solitary hair follicle that has become distended and clogged. Its visual signature is a single, raised, circular lesion with a prominent, dark center called the ostium. This dark material is a dense plug composed of oxidized keratin (a skin protein) and sebum (oil).
Unlike common blackheads, which are superficial and appear in clusters, a DPOW is typically solitary and can range from a few millimeters to over a centimeter in diameter. The dark plug is deeply embedded within the follicle, while the surrounding skin usually appears normal.
Structurally, the DPOW is a massive sac-like invagination of the epidermis that extends deep into the dermis. This depth and the rigidity of the accumulated keratin plug distinguish it from a simple, superficial comedo. The contents are firm and tightly packed, making simple squeezing ineffective for complete removal.
Formation and Risk Factors
A Dilated Pore of Winer is a slow-growing lesion resulting from the gradual clogging and enlargement of a single hair follicle opening. While the exact mechanism is not fully known, it is believed to begin with the accumulation of dead skin cells and oil within the follicular canal. This debris causes the follicle to dilate over time, forming the characteristic enlarged pore.
The condition is most frequently observed in middle-aged and older adults, with incidence increasing significantly after age 40. Men are more likely to develop a DPOW than women, and it is more frequent among white individuals. Chronic sun exposure is considered a major contributing factor, as solar damage can alter the skin’s texture and elasticity, leading to enlarged pores and debris accumulation.
A personal history of severe or cystic acne is also associated with increased risk. One theory suggests the initial event may involve scar tissue forming around a small cyst within the pore, causing subsequent dilation and enlargement. These factors combine to create the environment necessary for the long-term development of the lesion.
Why Professional Removal is Necessary
Attempting to squeeze or extract a Dilated Pore of Winer at home is strongly discouraged. The plug is resistant to manual pressure, and home attempts risk complications like inflammation, infection, and permanent scarring. Even if superficial material is removed, the remaining lining will continue to produce keratin, leading to rapid recurrence of the lesion.
The most effective and definitive treatment is surgical excision performed by a dermatologist. This procedure involves injecting a local anesthetic and using a punch biopsy tool or a small scalpel to completely remove the entire dilated follicle and its contents. Removing the entire wall of the follicular sac prevents the pore from refilling and ensures the lesion is cured.
For larger lesions, the dermatologist may use simple scalpel excision, which requires sutures to close the resulting opening, typically removed after about ten days. An alternative technique involves using a CO2 laser to precisely ablate the contents and the lining of the pore, minimizing damage to the surrounding skin. While simple extraction with a comedone extractor may be used for very small lesions, surgical removal remains the gold standard for long-term resolution of most DPOWs.