I agree its HITH, and one of the things that encourage the disease are high nitrates , and also other forms of stress. e.g. Temps too high, aggressive tank mates, etc etc.
If there are no other forms of stress, its probably high nitrate, these cichlids come from waters that usually present no detectable nitrate
SO I consider 20ppm too high, and a cause of this chronic condition.
If it were me, I'd would consider doubling the water change routine to keep it from reinfecting.
You can throw all the meds at HITH you want, but if the underlying cause is not dealt with, all the meds in the world won't keep it from returning.
My water change routine is between 120% and 160% per week.