Staphylococcal Angular Cheilitis — ORE Part 1 MCQ

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ModerateOral MedicineStaphylococcal Angular CheilitisORE Part 1

A patient has angular cheilitis that has not improved with topical miconazole. A swab from the lesion grows Staphylococcus aureus, with no Candida isolated. Which treatment is most appropriate?

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Correct answer: B — Apply topical fusidic acid cream

**A is correct.** The lesion has cultured *Staphylococcus aureus* and Candida has been excluded after failure of miconazole. Management should therefore change to a topical antibacterial: fusidic acid is licensed in the UK for skin infections caused by susceptible *S. aureus*. The angular commissures are cutaneous sites, so topical treatment is appropriate in this localised presentation. Increasing miconazole or prescribing fluconazole would continue antifungal treatment despite no Candida being isolated. Hydrocortisone alone may reduce erythema temporarily but does not eradicate the bacterial infection and is inappropriate as sole treatment. Continuing the current regimen disregards both microbiological results and clinical treatment failure. Addressing predisposing factors such as saliva pooling, reduced occlusal vertical dimension or denture fit would also be important if the condition recurs.

Reference: LEO Laboratories Ltd. Fucidin 20 mg/g Cream: Summary of Product Characteristics, sections 4.1 and 5.1, revised 01 June 2026. https://www.medicines.org.uk/emc/product/5510/smpc