Dilated pore of winer on scar: An unusual presentation

A 29-year-old woman presented with an asymptomatic reddish skin lesion with a blackish, rounded lesion on the left breast for the past 1 year. Cutaneous examination revealed an ill-defined, erythematous, non-tender, firm plaque of size 4 × 3 cm in diameter, with a rounded, comedo-like lesion with keratin plug, on the upper outer quadrant of the left breast [Figure 1a]. Skin biopsy revealed haphazard fascicle of dense collagen in dermis suggestive of scar tissue and markedly dilated follicular infundibulum filled with keratinous material and acanthotic epidermis suggestive of the dilated pore of Winer [Figure 1b]. It is important to distinguish dilated pore of Winer, a benign follicular tumor, from pilar sheath acanthoma, trichofolliculoma, and comedones.^[1] Considering the presence of scar in our patient, keratin material was removed using a comedone extractor, although surgical excision is usually curative. After the removal of the keratinous plug, topical silicone gel application was advised for scar management.

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Figure 1:

(a) Ill-defined, erythematous, firm plaque measuring 4 × 3 cm in diameter with a rounded, comedo-like lesion measuring 3 × 3 mm in diameter on the left breast. (b) Histology: Markedly dilated follicular infundibulum filled with keratinous material and acanthotic epidermis (H&E stain, ×10).

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