Paleness, also known as pale complexion or pallor, is an unusual lightness of skin color when compared with your normal hue. Paleness is caused by reduced blood flow or a decreased number of red blood cells. Paleness can be generalized (all over) or local. Local paleness usually involves one limb. You should see your doctor if you have sudden onset of generalized paleness or paleness of a limb.
Anemia, a condition in which the body doesn’t produce enough red blood cells, is one of the most common causes of paleness. Anemia can be acute (sudden onset) or chronic (developing slowly).
Acute anemia is usually the result of rapid blood loss from trauma, surgery, bleeding stomach ulcers, or bleeding from the colon.
Chronic anemia is very common. It can be caused by not having enough iron, B12 or folate in your diet. There are also genetic causes of anemia such as sickle cell disease and thalassemia (a genetic disorder that destroys red blood cells). Anemia that develops more slowly can be caused by diseases such as chronic kidney failure or hypothyroidism (when the body does not produce enough thyroid hormone). Certain cancers that affect the bones or bone marrow can also cause anemia due to slow blood loss over a period of weeks to months.
Other causes of paleness include:
- lack of exposure to sunlight
- skin that is naturally pale
- cold exposure and frostbite
- shock (dangerously low blood pressure)
- low blood sugar
- blockage in the artery of a limb (local paleness)
Skin color is determined by several factors, such as the amount of blood flowing to the skin, skin thickness, and the amount of melanin in the skin. Paleness also affects the inner membrane of the lower eye lids (conjunctivae), the palms of your hands and fingernails, your tongue, and the mucous membranes inside your mouth. According to the Journal of General Internal Medicine, paleness seen in the eyes is a reliable sign of anemia, regardless of race. It is also considered a sensitive indicator of severe anemia. Paleness can be a nonlife-threatening manifestation of emotions such as fear (“pale as a ghost”), or it can be a sign of serious medical problems such as severe anemia or frostbite. (JGIM)
Paleness often occurs along with other symptoms such as those associated with anemia. Symptoms of anemia vary based on the type of anemia.
Acute Onset Anemia
Symptoms of acute onset anemia include:
- rapid heart rate
- shortness of breath
- high or low blood pressure
- loss of consciousness
- irregular or absent menstrual period
Slowly developing anemia may have no symptoms other than paleness, fatigue, or sensitivity to cold. Heavy menstrual bleeding or occasional spots of blood after a bowel movement can also occur. Muscle or weight loss can be caused by cancer or malnutrition. Poor nutrition is a common cause of anemia in many parts of the world.
Arterial Blockage of a Limb
Arterial blockage (poor or lack of blood circulation) can cause localized paleness, typically in arms or legs. The limb becomes painful and cold due to lack of circulation.
Call your doctor right away if you suddenly develop generalized pallor. Paleness accompanied by signs of blood loss such as fainting, vomiting blood, bleeding from the rectum or abdominal pain is considered a medical emergency. Shortness of breath and sudden onset of paleness, pain and coldness of a limb are also serious symptoms that require immediate medical attention.
Your doctor will review your symptoms to determine which tests are needed to make a diagnosis. Your doctor will also review your medical history and perform a physical examination to check your vital signs (heart rate and blood pressure). Pallor can often be diagnosed on sight, but can be hard to detect in people with dark complexions. In people of color, pallor can be detected by loss of color in the eyes and mucous membranes. People who have sudden onset of pallor and severe symptoms, such as fainting and abdominal pain, are usually seen in the emergency room. People with paleness and symptoms such as fatigue and mild shortness of breath are usually seen in the doctor’s office.
The presence of pallor, a faint, rapid pulse and low blood pressure are signs that you are seriously ill. Abdominal pain and tenderness might mean that a problem with your abdominal organs is causing your pallor. If you experience these symptoms, your doctor may need to order additional tests to determine the underlying cause of your condition.
The following tests are used to evaluate paleness:
- CBC (complete blood count, evaluates if you have anemia)
- reticulocyte count (a blood test that shows if your bone marrow is replacing blood loss)
- stool test for the presence of blood
- serum pregnancy test (to rule out pregnancy)
- thyroid function tests (low levels of thyroid hormone causes anemia)
- BUN and creatinine (kidney function tests)
- serum iron, B12, and folate levels (to see if nutritional deficiency is causing anemia)
- abdominal X-ray (noninvasive test that uses X-rays to evaluate the status of abdominal organs)
- abdominal ultrasound (a noninvasive test that uses sound waves to detect problems)
- abdominal CAT scan (uses X-rays to make high definition images of abdominal organs)
- extremity arteriography (an invasive X-ray test where dye is injected into the artery of a limb to see if there is a blockage)
Treatment depends upon the cause of your pallor.
Treatment options include:
- balanced diet, and iron, B12 or folate supplements
- blood transfusion may be necessary
- surgery is an option for certain causes of acute blood loss, such as trauma. Surgery may also be required for treatment of arterial blockage.
The long-term consequences for nontreatment of pallor depend upon the underlying cause. Untreated anemia due to blood loss can be fatal. Severe nutritional anemia can lead to other long-term health issues. Untreated arterial blockage of a limb can result in gangrene, which can result in the loss of a limb.