Clinical significance of hyperkeratosis on otherwise normal Papanicolaou smears

Although hyperkeratosis is a common cytological finding on Papanicolaou smear, its clinical significance is unclear.

A profile of patients with hyperkeratosis was constructed by comparing them to an age-matched control population having normal Papanicolaou smears. The clinical significance of hyperkeratosis was evaluated and appropriate follow-up studies were recommended.

Of 2198 Papanicolaou smears done in the University of Kansas Family Practice Department between October 1, 1988, and October 31, 1989, there were 184 diagnoses of hyperkeratosis from smears on which no other pathological findings were noted. Charts of 183 of these patients with hyperkeratosis were reviewed and compared with an age-matched control population having normal Papanicolaou smears. Patients with hyperkeratosis had a statistically higher incidence of infections with Gardnerella vaginalis, but a lower incidence of infections with Chlamydia trachomatis. Diaphragm use was more prevalent in the group with hyperkeratosis. The incidence of inflammation on Papanicolaou smear was similar between the two groups. Of the patients with hyperkeratosis, colposcopic examination had been performed on 48% (88 of 183), of which 28% (25 of 88) had evidence of human papillomavirus or dysplasia.

Review of the data obtained suggests that follow-up colposcopy, including endocervical curettage, be performed on all patients with hyperkeratosis in order to screen for accompanying pathological conditions that may necessitate treatment.