Hi.
I've had acne since I was about 13 maybe, I'm now 27. When I was younger I was on acutane twice, antibiotics, seen dermatologists etc etc.
My acne has always been there but sometimes more under control. I'm gonna try and keep this a short as possible lol 
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7 years ago, during pregnancy I broke out really bad on my face, chest and back. But since then I have not had any breakouts on my chest and back and my face was pretty under control.
I recently went through a huge diet change, about 9 months ago. I've cut out gluten, most meat, and dairy. I was always told I had pcos, but a recent test of all my hormones came back completely normal. I quit smoking about 9 months ago as well, and switched to vaping.
So even after doing all that, my face started breaking out, the worst I can remember, and my back and chest again. So I did all that with my diet, I quit smoking and have normal hormone levels and Drink a ton of water, yet I continue to break out, and worse then other times.
Hi --- sorry you're going through this. I'm going through a flare-up myself. You're still very young and may outgrow acne yet. My kids outgrew their acne in their 30's. Yes the nicotine in your vapor cigs may be making things worse. Try quitting altogether. Try also cutting out sugar and sweet foods, as well as fried and oily foods like salad dressings. You may be dealing with rosacea along with acne. Google rosacea triggers...they are slightly different than acne triggers. Try to follow a diet and lifestyle that is recommended for rosacea. This will help acne too...if it is just acne.
If you did a blood hormone test then you may not be getting an accurate picture. Saliva testing is more accurate from what I've read and can offer more information in regards to any sensitivities your body may have. The gaping could definitely be making things worse but I would be surprised if it's the root cause.mmi understand your frustration as I made diet changes in 2011 and here I am in 2015 struggling. For many of ups, rarely is acne a one issue thing. Stay strong, don't give up and realize that you are not alone in the struggle.