Paleness, also known as pale complexion or pallor, is an unusual lightness of skin color compared with your normal complexion. Paleness may be caused by reduced blood flow and oxygen or by a decreased number of red blood cells.

It can occur all over your skin or appear more 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 your body doesn’t produce enough red blood cells. It’s one of the most common causes of paleness. Anemia can be acute with a sudden onset or chronic and develop slowly.

Acute anemia is usually the result of rapid blood loss from trauma, surgery, or internal bleeding, often from your 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, your 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. Certain cancers that affect your 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, including:

  • the amount of blood flowing to your skin
  • your skin’s thickness
  • the amount of melanin in your skin

Paleness may also be noted in the following areas:

  • inner membranes of your lower eye lids
  • palms of your hands
  • your fingernails
  • your tongue
  • mucous membranes inside your mouth

Paleness can be a 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 your inner eyelids is a telltale 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

Chronic anemia

In women, heavy menstrual bleeding is a common cause of chronic anemia. In many parts of the world, poor nutrition is a common cause. Sometimes, 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 your arms or legs. Your limb can become 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:

  • fainting
  • fever
  • vomiting blood
  • rectal bleeding
  • abdominal pain

Other serious symptoms that require immediate medical attention include:

  • shortness of breath
  • pain and coldness of a limb
  • chest pain with sudden onset of paleness

If you have a sudden onset of pallor as well as severe symptoms such as fainting, fever, and abdominal pain, you should head to the emergency room. If you develop paleness and symptoms such as fatigue and mild shortness of breath, you can usually be seen in your doctor’s office.

Paleness, 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 and 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 dark complexions. If you have a darker complexion, your doctor may check your inner eyelids and mucous membranes for a loss of color.

The following tests are used to evaluate causes of paleness:

  • Complete blood count (CBC). 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 culture. 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 pallor, is common in pregnancy.
  • Thyroid function tests. This series of tests checks your thyroid hormone levels. A low functioning thyroid can cause anemia.
  • Kidney function tests. Because kidney failure may cause anemia, your doctor may order a BUN or creatinine blood tests to check how well your kidneys are working.
  • Vitamin deficit scans. You doctor may order a serum iron, vitamin B-12, or folate level test 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 noninvasive test 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 X-ray test involves injecting dye 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, vitamin B-12, or folate supplements
  • taking medication or getting treatment to manage ongoing medical problems
  • surgery, usually only 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.