It sounds like you're experiencing a significant skin issue that could indeed be attributed to an imbalance in your doshas, particularly Pitta and potentially Kapha, since the symptoms include redness, itchiness, and scaling. In Ayurveda, skin conditions often reflect internal imbalances, and using natural remedies can be a holistic approach to address both the symptoms and the root causes. For topical treatment, Neem can be very effective due to its antifungal, antibacterial, and anti-inflammatory properties. You can create a paste by grinding fresh Neem leaves or using Neem powder mixed with water or coconut oil, applying it directly to the affected areas for 20 minutes before rinsing with lukewarm water. Turmeric also holds great potential; you can make a paste with Turmeric powder and water or Aloe Vera gel and apply it to the patches, leave it on for about 30 minutes, and rinse off. This can help reduce inflammation and promote healing. Aloe Vera is fantastic for soothing the skin as well, and you can apply the gel directly from the plant to help cool the skin and keep it hydrated. In addition to topical applications, internal detoxification is crucial. Incorporate a Pitta-pacifying diet rich in fresh fruits and vegetables, while avoiding spicy, oily, and acidic foods which can exacerbate heat in the body. Include cooling herbs in your diet, like fennel and coriander. Drinking warm water with a teaspoon of apple cider vinegar can also help balance your internal environment. It's also beneficial to take Triphala, which supports digestion and detoxification. Regarding ketoconazole cream, while it is effective for fungal issues, it's wise to approach all creams cautiously, especially with sensitive skin. Expanded use of Ayurvedic treatments provides a holistic approach, supporting your skin's health without the long-term reliance on medicated creams. Keep your skin moisturized with natural oils like sesame or coconut oil to maintain balance and prevent dryness. Focus on self-care routines that soothe and nourish your skin, which can enhance your overall well-being. If the patches continue to spread or worsen, consider consulting an Ayurvedic practitioner for a personalized treatment plan.