TABLE 57.2 CAUSES OF DYSURIA: DERMATOLOGIC CONDITIONS Disorder Age Signs and symptoms Psoriasis All Pruritis Physical examination Sharply demarcated erythematous, thick, silver-scaled plaques of the scalp, elbows, and knees; may also involve nails, joints, axilla, and groin Lichen Infants and young Dry, tender, and Depigmentation in sclerosis children severely pruritic anogenital area (most (mostly female) white plaques common) If no discharge is seen, urinalysis will identify the possibility of urinary tract infection (UTI) (see Chapter 94 Infectious Disease Emergencies ) Clinical suspicion should remain high among those with a history of dysuria, prolonged fever, prior history of UTI or abnormal urinary tract, presence of fever, and flank pain suggesting pyelonephritis Urinalysis or urine dipstick evaluations are performed as screening tools on urine collected via clean-catch technique following cleaning of the perineum or urethral catheterization using sterile technique A positive result on urine dipstick (moderate or large leukocyte esterase and/or positive nitrites) or the presence of pyuria on microscopic urine analysis (≥5 WBC/hpf and bacteriuria) increases the likelihood of bacterial infection (urethritis, cystitis, or pyelonephritis) Infection is confirmed by culture results meeting colony forming unit (CFU) criteria in the presence of a urinary pathogen Inflammatory conditions, such as chemical urethritis, and nonbacterial infections may also evoke a leukocyte response Empiric antibiotic therapy may be initiated based on urine dip or urinalysis results pending urine culture results