Pyramid Butterfly ID skin change please

(Compared to my Pyramid, I had a Pearlscale Butterfly that always looked gorgeous!)
Just an update. The Pyramid graduated from Hospital tank to observation Tank. Total of 5 sand corn size nodules, stationary , no grow. Will see how things will be in a month.
 
There isn't anything such as "gill ich", Cryptocaryon prefers to subsist on a fish's skin, but will invade the gills in severe infections. Typically, people misdiagnose Amyloodinium (velvet) as "gill ich" due to the propensity of that disease to infect the gills first and cause rapid breathing. The spots of velvet can be surprisingly large, causing people to think it is ich.

As was mentioned, the larger white spots are pretty common on new pyramids, I never worry about them. What I do worry about are Neobenedenia flukes. This species almost always has these. Given that your LFS ran a sub-therapeutic copper level, I would also doubt their "deworming" as Neo is very difficult to control. If you see cloudy eyes on this fish, or tattered fins for no reason, consider giving it a 5 minute diagnostic FW dip to look for Neo. That will show up at the bottom of the dip container like tiny gray scale looking things.

Sorry - I can't tell you why the first one died....

Jay
So this Pyramid Butterflyfish had ick and spend 2weeks in effective copper, then dry transfer to bucket and dry transfer to 120g observation tank. Now 30 days later, I still get to see white, sand corn size lesions that do not seem to follow an infectious picture. They occur singularity or 2, come and go. Initially singular under the jaw. These spots are now singular on tail fin and pectoral fin. Only “therapy” is a UV sterilizer. I have no rush to transfer to display, fish eats well, no behavioural changes. Any good ideas?
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I find a properly sized uv with the right flow is a great way to help your fish stay/get healthy
 
Just an update. The Pyramid is graduating to the Display! Initial hazing by the black Pytamid and YT, so I put in a tank divider for the next few weeks.
 
I haven't had luck with Pyramids. They seem highly susceptible to internal infections. I had gotten two, one died in less than 24 hours. The other lasted about a year then went bonkers. It wouldn't stop swimming fast and aimlessly, breathing heavy, and kept getting attached to powerheads. I had treated with 2 rounds of Prazipro just to make sure it wasn't flukes, and a month after the prazi treatments it just went bonkers. I don't know what it was. I'm done with Pyramids. . I have a healthy copperband butterflyfish that's doing great, and eats from my hand everyday and no signs of issues. I've had him 14 months now with no signs of deterioration or infection. So, I'm happy with the CBB. I don't know what it is about pyramids but I haven't seen healthy ones of them.
 

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