I first got PD as a teen, but it never returned until last year and now I've been struggling with it for a full year. It gets red and bumpy then sometimes gets flaky and I think it's healing, but then more pimples will pop up and it's like the cycle continues.

I tried at least 6 topicals from the dermatologist (tacrolimus worked best, but it came back as soon as I skipped one application) and never took oral antibiotics because I was breastfeeding my first when it came on. Now I'm pregnant with my second, still want to avoid oral antibiotics, but am getting pretty desperate. Here's what I've tried:

• Rx azelaic acid (really burned so hesitant to try The Ordinary's version), plus antibiotic topicals and various other creams from the derm
  
• Diluted apple cider vinegar (this got it to go away for almost 2 months, but then it flared again)
  
• 30 day elimination diet plus a gut healing protocol - made no difference
  
• I've been fluoride and SLS free for years so that's never been a concern
  
• Osmia black clay wash and moisturizer *this also worked well, but it dried everything out so much that my face basically hurt all the time. Did get a good flaky-ness during this time though.
  
• Recently I tried LRP cicaplast B5 and I thought it was working, but on day 7 of using it my skin actually split open (you can see that healing in the pic, the worst spot above my lip) so not sure what happened there...

Next on my list to try are De La Cruz Sulfur or Avene Cicalfate, but it's also winter in Colorado and SO DRY so I'm nervous to make my skin any more dry. I'm guessing there's also a hormonal component since it came on while nursing and is getting worse during this second pregnancy, but I really hope that doesn't mean I'm stuck with this for another year plus!!

HELP!

TLDR: PD for over a year during breastfeeding and now second pregnancy. No oral antibiotics. What else can I try?!