Thanks Mark,
I have tried to treat a couple of these. The are tough and stubborn. Like you said, a lot is tied to their immune status (i.e stress).
Modification of the tissue itself–with a shallow penetrating wavelength like CO2 or erbium followed by near IR laser for biostim would be my choice for symptomatic and temporary relief.
They need to address the underlying cause of thier condition for our efforts to contribute to any long term result.
Bob