59 y/o Latino female with a pmhx of asthma, hyperlipidemia, | Figure 1

59 y/o Latino female with a pmhx of asthma, hyperlipidemia, A1C 5.8 % presents to the clinic with a new onset "rash" that started approximately 8 months ago. She states it started on her abdomen bilaterally in the left lower quadrant bilaterally and then extended to her brachium and antecubital fossa on both arms. She has some pruritus and a "tickling sensation" occasionally in the affected areas. Denies any burning, stinging or any other sensations. The areas of pigmentation change occurred over the last few months. ROS: negative. Family history: non-contributory. Any help appreciated. TY

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