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Ro screens for contraindications including thyroid cancer history, kidney disease, and cardiovascular risk

Use ketoconazole tablets with caution in patients with cardiac disease or other conditions that may increase the risk of QT prolongation including cardiac arrhythmias, congenital long QT syndrome, heart failure, bradycardia, myocardial infarction, hypertension, coronary artery disease, hypomagnesemia, hypokalemia, hypocalcemia, or in patients receiving medications known to prolong the QT interval or cause electrolyte imbalances

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If the pigmentation is new, changing, or accompanied by symptoms, it deserves its own evaluation - separate from your cosmetic recovery