Paleness, also known as pale complexion or pallor, is an unusual lightness of skin color as compared to your normal complexion. Paleness may be caused by reduced blood flow and oxygen or by a decreased number of red blood cells. It can be generalized (all over) or localized. Localized paleness usually involves one limb. You should see your doctor if you have sudden onset of generalized paleness or paleness of a limb.
Anemia is a condition in which the body doesn’t produce enough red blood cells. It’s one of the most common causes of paleness. Anemia can be acute, meaning it has a sudden onset, or chronic, meaning it develops slowly.
Acute anemia is usually the result of rapid blood loss from trauma, surgery, or internal bleeding, often from the stomach or intestinal tract.
Chronic anemia is common. It can be caused by a lack of iron, vitamin B-12, or folate in your diet. There are also genetic causes of anemia, such as sickle cell disease and thalassemia. In these conditions, the body makes ineffective hemoglobin. This is the protein in red blood cells that carries oxygen. Chronic anemia can also 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 poor production of blood cells over a period of weeks to months.
Other causes of paleness include:
- lack of sun exposure
- skin that is naturally pale
- cold exposure and frostbite
- shock (dangerously low blood pressure)
- blockage in the artery of a limb
Skin color is determined by several factors, such as the amount of blood flowing to the skin, the skin’s thickness, and the amount of melanin in the skin.
Paleness may also be noted in the following areas:
- the inner membranes of the lower eye lids
- the palms of your hands
- your fingernails
- your tongue
- the mucous membranes inside your mouth
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, bloodstream infection, or frostbite.
Paleness in the inner eyelids is a reliable sign of anemia, regardless of race. It is also considered a sensitive indicator of severe anemia.
Paleness often occurs along with other symptoms, such as those associated with anemia. Symptoms of anemia vary based on the severity.
Acute onset anemia
Symptoms of acute onset anemia can include:
- rapid heart rate
- chest pain
- shortness of breath
- low blood pressure
- loss of consciousness
In women, heavy menstrual bleeding is a common cause of chronic anemia. In many parts of the world, poor nutrition is a common cause. Chronic anemia may have no symptoms other than paleness, fatigue, or sensitivity to cold.
Arterial blockage of a limb
Arterial blockage, or a lack of blood circulation, can cause localized paleness. This typically occurs in the 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 is considered a medical emergency when it’s accompanied by symptoms such as:
- vomiting blood
- bleeding from the rectum
- abdominal pain
Other serious symptoms that require immediate medical attention include shortness of breath, pain and coldness of a limb, and chest pain with sudden onset of paleness.
People who have a sudden onset of pallor as well as severe symptoms such as fainting, fever, and abdominal pain should be seen in the emergency room. People with paleness and symptoms such as fatigue and mild shortness of breath can usually be seen in the doctor’s office.
Pallor, low blood pressure, and a faint, rapid pulse are signs that you’re seriously ill. Abdominal pain and tenderness might mean that internal bleeding is causing your pallor. If you experience any of these symptoms, your doctor may need to order additional tests right away to determine the underlying cause of your condition.
Your doctor will review your symptoms to choose which tests will help them make a diagnosis. They will also review your medical history, perform a physical examination, and check your heart rate and blood pressure. Pallor can often be diagnosed by sight, but it can be hard to detect in people with dark complexions. In these people, pallor can be detected by checking the inner eyelids and mucous membranes for a loss of color.
The following tests are used to evaluate causes of paleness:
- CBC (complete blood count): This blood test helps evaluate if you have anemia or infection.
- Reticulocyte count: This blood test helps your doctor see how well your bone marrow is working.
- Stool test: This test checks for the presence of blood in your stool, which may indicate internal intestinal bleeding.
- Serum pregnancy test: This test rules out pregnancy. Anemia, which can cause of pallor, is common in pregnancy.
- Thyroid function tests: This test checks your thyroid hormone levels. A low functioning thyroid can cause anemia.
- BUN and creatinine blood tests: Because kidney failure may cause anemia, your doctor may order these tests to check how well your kidneys are working.
- Serum iron, vitamin B-12, and folate level tests: You doctor may order these tests to see if a nutritional deficiency is causing the anemia.
- Abdominal X-ray: This is a noninvasive test that uses X-rays to check your abdominal organs.
- Abdominal ultrasound: This is a noninvasive test that uses sound waves to detect problems in your body.
- Abdominal CT scan: This test uses X-rays to form high-definition images of the organs and blood vessels in your abdomen.
- Extremity arteriography: This is an invasive X-ray test. Dye is injected into the artery of a limb to help your doctor see if there is a blockage.
Treatment depends on the cause of your pallor. The options can include:
- following a balanced diet
- taking iron, B-12, or folate supplements
- taking medication or getting treatment to manage ongoing medical problems
- surgery (in severe cases of acute blood loss or for treatment of arterial blockage)
The consequences of untreated paleness depend on the underlying cause. Acute cases of pallor require immediate medical attention. Ongoing paleness can often be treated with medication. However, having the correct diagnosis about what’s causing your paleness is key to timely and proper treatment.