Overview
Noninfectious colitis encompasses various inflammatory conditions of the colon not caused by infectious agents, often linked to medication-induced photosensitivity, dietary factors, or other non-infectious triggers. 15Diagnosis
Clinical Presentation: Symptoms include abdominal pain, diarrhea, and sometimes bloody stools.
Phototesting: Useful in identifying photosensitivity reactions, particularly in suspected drug-induced cases. 47
Skin Biopsy: May reveal characteristic histopathological changes in cases of photosensitivity reactions. 9
Patch Testing: Essential for diagnosing contact dermatitis in photosensitive patients. 8
Laboratory Tests: Include complete blood count, stool cultures (to rule out infection), and specific assays for suspected drug reactions.
Endoscopic Evaluation: Colonoscopy can help visualize mucosal changes and obtain biopsies. 6Management
Discontinue Triggering Agents: Stop or switch medications known to cause photosensitivity or colitis (e.g., tetracyclines, diuretics). 159
Photoprotection: Advise strict sun protection measures including sunscreen, protective clothing, and avoidance of peak sunlight hours. 13
Supportive Care: Include hydration, electrolyte management, and symptomatic relief with antidiarrheals as needed.
Nutritional Support: Consider dietary modifications to avoid known triggers and ensure adequate nutrition.
Immunomodulatory Therapy: In refractory cases, corticosteroids or other immunomodulatory agents may be necessary. 6Special Populations
Elderly: Increased risk of photosensitivity reactions and potential drug interactions; careful medication review essential. 5
Pregnancy: Limited data; avoid known photosensitizing drugs if possible; consult specialized guidelines for colitis management. 5
Comorbidities: Patients with inflammatory bowel disease may require tailored approaches considering their underlying condition. 6Key Recommendations
Identify and Discontinue Photosensitizing Medications: Prioritize discontinuation of drugs like tetracyclines and diuretics known to cause photosensitivity reactions. (Evidence: Moderate) 159
Implement Strict Photoprotection Measures: Advise patients on comprehensive sun protection strategies to mitigate photosensitivity risks. (Evidence: Moderate) 13
Consider Colonoscopy for Diagnostic Clarity: Use endoscopic evaluation to confirm diagnosis and assess mucosal changes in suspected cases of noninfectious colitis. (Evidence: Weak) 6References
1 Nakao S, Hatahira H, Sasaoka S, Hasegawa S, Motooka Y, Ueda N et al.. Evaluation of Drug-Induced Photosensitivity Using the Japanese Adverse Drug Event Report (JADER) Database. Biological & pharmaceutical bulletin 2017. link
2 Kerstein RL, Lister T, Cole R. Laser therapy and photosensitive medication: a review of the evidence. Lasers in medical science 2014. link
3 Rhodes LE, Webb AR, Berry JL, Felton SJ, Marjanovic EJ, Wilkinson JD et al.. Sunlight exposure behaviour and vitamin D status in photosensitive patients: longitudinal comparative study with healthy individuals at U.K. latitude. The British journal of dermatology 2014. link
4 Crouch RB, Foley PA, Baker CS. Analysis of patients with suspected photosensitivity referred for investigation to an Australian photodermatology clinic. Journal of the American Academy of Dermatology 2003. link
5 Selvaag E. Clinical drug photosensitivity. A retrospective analysis of reports to the Norwegian Adverse Drug Reactions Committee from the years 1970-1994. Photodermatology, photoimmunology & photomedicine 1997. link
6 Cataldo PA. Colonoscopy without sedation. Diseases of the colon and rectum 1996. link
7 Diffey BL, Farr PM, Ive FA. The establishment and clinical value of a dermatological photobiology service in a district general hospital. The British journal of dermatology 1984. link
8 Cronin E. Photosensitivity to musk ambrette. Contact dermatitis 1984. link
9 Epstein JH, Tuffanelli DL, Seibert JS, Epstein WL. Porphyria-like cutaneous changes induced by tetracycline hydrochloride photosensitization. Archives of dermatology 1976. link