Skin lesions and itch

A 40-year-old woman is referred to the dermatology clinic with a history of erythematous skin lesions appearing on her face, neck and chest over the past six weeks. She complains of a burning and slight itching with the onset of new lesions that then settle over a few weeks leaving marked pigmentation on her skin. Intermittently she has developed new lesions in addition to the old lesions flaring. She had no previous history of skin problems. Past medical history includes mild asthma, hay fever and hypertension. 

Her medication includes becotide and salbutamol inhalers, simvastatin, atenolol and ramipril; the latter was commenced within the last 2 months to help control her hypertension.

Examination 

There are multiple annular hyperpigmented macular lesions on the skin over her face, neck and upper chest. No new erythematous lesions or recently ‘reactivated’ lesions are apparent at the time of this clinic appointment.