A 29-Year-Old Woman, Gravida 2 Para 0 Aborta 1, at 34

A 29-year-old woman, gravida 2 para 0 aborta 1, at 34 weeks gestation comes to the office for a routine prenatal visit.  She reports no abdominal pain, leakage of fluid, or vaginal bleeding.  There is normal fetal movement.  Since her last visit 2 weeks ago, she has developed severe pruritus on her abdomen, which has not responded to over-the-counter moisturizers.  The patient has had no recent contact with anyone who has had a fever, rash, or pruritus.  She was diagnosed with gestational diabetes mellitus that is well controlled with an insulin regimen.  Earlier in the pregnancy, she had an episode of vulvar candidiasis that was treated with a topical antifungal.  The patient has no chronic medical problems or previous surgeries.  She takes prenatal vitamins daily and has no allergies.  The patient does not use tobacco, alcohol, or illicit drugs.  Temperature is 36.7 C (98 F) and blood pressure is 100/70 mm Hg.  BMI is 31 kg/m².  Fetal heart rate is 145/min and fundal height is 35 cm.  Physical examination shows prominent abdominal striae and several red linear excoriations on the abdominal wall unrelated to the striae.  Laboratory results are as follows: Which of the following is the best next step in treatment of this patient?

A) Oatmeal baths
B) Oral acyclovir
C) Oral fluconazole
D) Oral ursodeoxycholic acid
E) Topical triamcinolone