A 15-year-old girl who recently moved from India to the United States presents to dermatology clinic with chief concern of the pictured rash.  She has previously undergone treatment with 4 weeks of daily terbinafine, as well as 6 weeks of fluconazole, without resolution.  KOH reveals numerous branching hyphae.

Which of the following is the most appropriate next step?

A. Initiate topical corticosteroids

B. Initiate topical ketoconazole

C. Initiate oral itraconazole

D. Initiate oral voriconazole

E. Initiate oral posaconazole

F. Initiate biologic therapy

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