What is your approach to diagnosis and treatment to intermittent cheilitis that does not respond to anti fungal therapy?

Clinical features matter. The differential is broad: granulomatous cheilitis, contact dermatitis, irritant dermatitis, lichen planus, and I have even seen SCLE present with cheilitis. Biopsy during a flare can be helpful even if only to rule out some possibilities, and a 3mm punch typically heals qu...