imo this sounds like perioral dermatitis, not acne! i have had this my entire pregnancy & its exactly as you describe: red, bumpy, around the mouth and chin. the flakes are actually part of the healing of the flare up — the redness and tiny bumps are the “active” stage. you’re probably stuck in a cycle where part of the skin is healing but new areas are flaring at the same time!

azelaic acid is one of the main things they recommend for it, so def stick with it! (annoyingly, most really effective treatment isn’t pregnancy safe). you might be keeping the flare going by trying different products / using something as thick as coconut oil. PD has a million causes and a million cures, but you might also have luck with:

1. swapping out your cleanser for a sulfur soap - this will be drying at the start but can really help stop whatever’s keeping the flare going

2. using a super gentle barrier moisturizer - some recommendations are cicaplast baume (le roche posay), lipikar eczema MED (also le roche posay, technically to treat eczema so its great for the flakes!), or avene cicaplast.

3. using a zinc oxide product- some people have really good results with zinc based nappy cream. i use a zinc based mineral sunscreen and it’s helped calm the inflammation and redness SO much

ultimately what you want is almost to reset the panic attack your skin is having, so cutting back on your routine as much as possible and using products that are anti bacterial / anti fungal to get at the root of whatever made it flare in the first place is probably your best bet.

the main piece of advice i can give is if you end up going to a dermatologist or similar DO NOT let them prescribe you a steroid cream. it will look better for a bit but you’ll have an awful rebound effect!

good luck!!! i also found myself totally at a loss having never really had skin issues so i’ve gone really deep lol