If you are female, it might be a problem of low progesterone; I have had this type of acne and it responds amazingly well to natural progesterone cream applied on a thin-skinned part of your body in a measured dose. I would start, though, with zinc which is a precursor to progesterone. It helps me tremendously. I notice a difference in a few days after taking zine supplements (up to 50 mg I think is fine). Of course, sugar (i.e., too many carbs) is a big problem. Are you sensitive to dairy? The best skin I have ever had was a product of an almost paleo regimen. I could tell a huge difference when I added dairy back in on the third phase of the Fat Flush diet. Of course, you also add other carbs during that phase, as well. Probiotics would be another good step if you haven't tried that already.
One thing a lot of people don't get is that skin almost always gets worse before it gets better. It's like whatever is in there has to come out and it comes out as break-outs and rashes. I have found a lot of help with the Skintervention Guide by Liz Wolfe. Her book is what convinced me to go primal again and I'm really grateful to her for that.
True healthcare reform starts in your kitchen, not in Washington. ~Anonymous
The worst carrot is better than the best candybar.--TornadoGirl