The white patches in your mouth could be oral thrush, which can sometimes occur with certain medications, or another manageable condition. Please have a healthcare provider examine your mouth to provide an accurate diagnosis and appropriate treatment, such as a mild antifungal rinse. For your diet, try to focus on soft, non-acidic, and non-spicy foods to prevent irritating your mouth. Staying well-hydrated and practicing gentle oral hygiene will also provide comfort.

A G6PD level of 18.6 is normal and not deficient, which is excellent news. The primary concern with dapsone is in individuals with G6PD deficiency (low levels), which can lead to red blood cell breakdown. Since her G6PD levels are healthy, dapsone is generally safe for her to take from this standpoint. However, because she is 75, please ensure her doctor reviews her complete health profile and current medications before she starts.

Since your current treatment with dapsone, topical betamethasone, and topical tacrolimus has not brought improvement, please consult your specialist to discuss alternative options. Other medical treatments include systemic retinoids (such as acitretin) or alternative immunosuppressive medications (like azathioprine, cyclosporine, or mycophenolate mofetil). Non-drug therapies, such as laser therapy or photodynamic therapy, can also be highly effective. Additionally, ask your doctor to rule out secondary oral yeast infections, which commonly occur with prolonged topical steroid use and can delay healing. Rest assured, there are still many effective pathways to explore to help manage your condition.

Dapsone can cause red blood cell breakdown in people with low G6PD levels (deficiency). Because her level is high, she is not deficient, making it much safer for her to take dapsone for her skin condition. However, because this medication can still affect red blood cells even with normal G6PD levels, her doctor will likely recommend regular blood tests to monitor her blood counts closely. Please share these positive results with her doctor to safely plan her treatment.

A bacterial level of 4+ indicates Multibacillary leprosy, which requires immediate, specialized treatment. The standard treatment recommended by the WHO is Multidrug Therapy (MDT), which consists of a combination of three medicines: Rifampicin, Dapsone, and Clofazimine, typically taken for 12 months. Since you have seen no relief in two years, it is critical that you consult a dermatologist or leprologist immediately. You need to be evaluated for drug resistance or leprosy reactions. Please do not self-medicate, as strict adherence to a supervised regimen is essential to cure the infection and prevent permanent nerve damage.

Please contact your doctor right away if you experience shortness of breath or blue-tinted skin. The reassuring news is that we have many safe alternatives for lichen planus pigmentosus. Your dermatologist might recommend topical options like tacrolimus ointment or topical corticosteroids, which treat the skin directly with very low risk of systemic side effects. Other options like oral retinoids can also be considered.