Derm Dx: Grey-brown discoloration around the mouth and nose

A 39-year-old Hispanic woman complains of discolored skin around her mouth and nose. She is unsure how long it has been present.

The patient reports that she tried using a “bleaching cream” without improvement. Her past-medical history is significant for acne for which she previously took minocycline. She denies prescription medications but is currently drinking a daily homeopathic “weight-loss” tea. ...