You’ve probably heard many different things cause acne. Doctors say it’s caused by bacteria and blockages in skin pores. Many natural health websites say diet and hormones cause acne.
So which one is correct? Both are. Before we dive deeper, let’s take a moment to understand distal and proximal causes. This helps to bridge the gap between the above two explanations.
Wikipedia defines distal and proximal causes like this.
A proximate cause is an event which is closest to, or immediately responsible for causing, some observed result. This exists in contrast to a higher-level ultimate cause (or distal cause) which is usually thought of as the “real” reason something occurred.
Proximate and ultimate causation – Wikipedia
Further from the Wikipedia article:
Example: Why did the ship sink?
– Proximate cause: Because it was holed beneath the waterline, water entered the hull and the ship became denser than the water which supported it, so it could not stay afloat.
– Ultimate cause: Because the ship hit a rock which tore open the hole in the ship’s hull.
In most situations, an ultimate cause may itself be a proximate cause for a further ultimate cause. Hence we can continue the above example as follows:
Example: Why did the ship hit the rock?
– Proximate cause: Because the ship failed to change course to avoid it.
– Ultimate cause: Because the ship was under autopilot and the autopilot’s data were inaccurate.
Separating proximate from ultimate causation frequently leads to better understandings of the events and systems concerned.
Now let’s apply this to acne.
The proximal causes in acne include:
- Bacterial overgrowth in skin pores
- Skin cell overgrowth
- Too much sebum
- Too much keratin
- Inflammation in the skin pores
The distal causes include:
- Hormonal imbalance
- Insulin resistance
- Systemic inflammation
Which are proximal causes of the following distal causes:
- Improper diet
- Too much stress
- Gut problems (which itself is a proximal cause, something we’ll cover in detail in the gut health chapter)
I hope this ties together and helps you to make sense of the many competing explanations of acne. The problem is that many such explanations focus on a small part of the larger process and don’t look at acne formation holistically.