Need some detoxes / cleanses. Colon cleanse, kidney cleanses, liver flushes.
It helps to do 1 day or 3 day diluted juice fasts.
I'm partial to raw paleo diet.
There's also the possibility of too much protein.
Also the quality of your food.

Other non food, rest, chemicals you put on your body, etc.

I find stress can bring on spots pretty quickly

Thanks everyone. To answer your questions: I have already tried a 3 day raw veggie smoothies cleanse. I eat only grass fed or pastured meat.  I eat lots of veggies, small amounts of fruit, an occasional sweet potato. I cook with coconut oil, or bacon fat.  I also eat fermented foods and drink lots of water, green tea and kombucha .  My only "cheats" are occasional paleo cookies or paleo banana bread like at thanksgiving, birthdays and Christmas. I did read where using coconut oil on my face at night might help. Has anyone tried that?

I've noticed a distinctive relationship between fat intake (particularly omega 3 fatty sources like fish oil) helps with keeping my skin in check. Having said that, I haven't ever really had bad skin.

Are you supplementing for omega 3?