Can you take another picture or two? The spots appear to be large and raised which leads me to think maybe not ich. What are you test salinity with? Hypo is extremely difficult to administer effectively for 30 days straight
Looks like flukes to me but I'm no expert o think for flukes you treat with cupramine
PraziPro is the treatment for flukes and I have already completed one treatment (5 days) and started another one after 30% water change.