A large blackhead that keeps coming back can, in fact, be a dilated pore of Winer (DPOW). However, these giant comedones are not a type of acne like blackheads. Learn more about what DPOWs are and their removal.
Blackheads are a common skin problem, and sometimes you may see a giant blackhead. No matter how many times you squeeze it, it keeps coming back. This large black pore is a dilated pore of Winer, sometimes called DPOW.
This has distinct features that can help differentiate it from other skin lesions.
What is it?
A dilated pore of Winer (DPOW) is characterized by an enlarged pore filled with keratin, resembling a large blackhead. First described by Louis H. Winer in 1954, it is actually a benign tumor.
They are commonly seen on the head, neck, or face but may also appear on the torso, especially on the back.
These large comedones are more commonly seen in middle-aged or elderly individuals, over 40 years. However, there are reports of them being seen in individuals as early as 20 years. Also, it is more common in men and Caucasians.
Symptoms and appearance
A DPOW appears as a single, enlarged pore with a blue-to-black plug. The surrounding skin may be normal or may show signs of actinic or sun damage.
The dilated pore can range in size from a few millimeters to more than a centimeter. It is usually asymptomatic, meaning it does not cause pain or discomfort.
However, if the pore is injured, squeezed, or picked, it can become painful, red, or even infected.
Causes
In the past, several theories such as that the dilated pore of Winer may be a cyst have been proposed, but it is considered to be a neoplasm/tumor.
The exact cause of this massive comedone is not known. A history of severe acne or cystic acne may be associated with the development of DPOW. Sun damage may also contribute to its formation.
Large blackhead vs. Dilated pore of Winer
Blackheads, also known as open comedones, are a type of acne that are smaller in size and typically appear in clusters on areas of the skin with high oil production, such as the face and back.
On the other hand, a Winer’s pore is a much larger, solitary lesion that resembles an enlarged blackhead. Occasionally, you may see more than one lesion.
Unlike blackheads, which are more common and can be seen in individuals of all ages, especially adolescents, DPOWs are more likely to occur in middle-aged and older adults.
Diagnosis
The diagnosis is usually made through visual examination by a healthcare provider. A dilated pore of Winer can be easily distinguished from other skin conditions based on its appearance. A skin biopsy is rarely needed.
Is it cancerous?
A dilated pore of Winer is not cancerous. However, some basal cell carcinomas (BCCs) can have an associated dilated pore.
It may also resemble other benign skin lesions such as:
- Large blackheads
- Pilar sheath acanthoma
- Trichofolliculoma
- Epidermal inclusion cyst with a punctum
So, one should have the lesion examined by a doctor for the correct diagnosis.
Treatment
No treatment is necessary for DPOW unless it becomes infected or is a cosmetic concern.
For temporary relief, the contents can be removed with a comedone extractor. But mere removal of the keratin plug won’t stop it from coming back as the pore can fill up with the keratin plug again. Also, don’t try to squeeze it at home, to avoid the possibility of infection and scarring.
For permanent removal of the dilated pore of Winer, it needs to be removed surgically followed by stitches.
Other treatment measures that may be used but are considered less efficacious include cryotherapy, electrodesiccation, electrocautery, laser surgery, and dermabrasion.
Prevention
There is no specific way to prevent DPOW as the underlying cause is not clear. However, since they are associated with a history of cystic acne and sun damage, using sun protection and ingredients that may help with acne may be useful, although there is no evidence or studies to support this.
Takeaway
A dilated pore of Winer is a benign skin condition that is not dangerous to overall health. Although it may be a cosmetic concern for some individuals, it usually does not require treatment unless it becomes infected or is being addressed for cosmetic reasons. It is also important to distinguish it from other skin lesions that may appear similar.
References
- Benedetto AV, Benedetto EA, Griffin TD. Basal cell carcinoma presenting as a large pore. J Am Acad Dermatol. 2002 Nov;47(5):727-32. doi: 10.1067/mjd.2002.124075. PMID: 12399765.
- Benedetto CJ, Riley CA, Athalye L. Dilated Pore of Winer. 2022 Sep 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30422562.
Disclaimer: This article is for information purposes only and does not replace medical advice.