Bilateral erythema of the anterior lower legs

A patient in a skilled nursing facility presents with “a rash” on their legs. Physical examination reveals bilateral erythema of the anterior lower legs and 3+ edema of the mid-calf. The calves are also covered with scattered telangiectasias, and the medial ankle area is discolored (dark brown, see image). In addition, the patient states their lower legs are slightly painful and itchy. Which of the following is the most appropriate initial management?

1. Leg elevation, regular exercise, and compressive stockings

2. antibiotic ointment

3. discontinuation of the offending medication

4. Biopsy

5. referral to a vascular surgeon