If angular cheilitis does not heal after two weeks of topical antifungals, what is recommended next?

• A. Biopsy
• B. Increase topical antifungals dose
• C. Switch to antibiotics
• D. Do nothing

Answer: (A)

When a lesion at the corners of the mouth doesn’t improve after a full two weeks of appropriate antifungal treatment, the next step is to reassess the diagnosis with a tissue sample. Persistent angular cheilitis can be caused by factors other than a fungal infection—bacterial infection, contact dermatitis, nutritional deficiencies, denture-related trauma, or less commonly, malignant or pre-malignant changes such as squamous cell carcinoma or actinic cheilitis. A biopsy provides a definitive tissue diagnosis, letting the clinician confirm whether the problem is still infection, another inflammatory process, or a more serious pathology that requires a different treatment approach.

Increasing the antifungal dose without re-evaluating the cause risks missing a non-fungal or malignant issue. Switching to antibiotics might be considered later if bacterial infection is suspected or confirmed, but it’s not the best next move without diagnostic information. Doing nothing isn’t appropriate when there’s a non-healing lesion.