Pale Skin (Pallor)

How to tell if you are pale

Skin color depends on melanin, blood flow and the amount of hemoglobin (the red, oxygen-carrying protein) in the blood. Pallor is easier to judge in places where melanin does not mask blood color:

• inner lower eyelid: pull down gently. Normal is pink-red; pale is whitish-pink
• lips, gums and tongue
• nail beds and palms: pale palm creases suggest significant anemia

In people with darker skin, pallor can look ashen, gray or yellowish-brown rather than white. Comparing with your own normal appearance, or with others, helps.

Sudden pale skin: causes

What to do for sudden pallor

• Have the person lie down and raise their legs if they feel faint.
• If they have diabetes and are conscious, give 15 g of fast sugar (juice, regular soda or glucose tablets), then recheck.
• Call 911 or your local emergency number if they do not recover quickly, have chest pain, are bleeding, or are confused or unresponsive.

Gradual pale skin: causes

Anemia (most common)

Anemia means too few red blood cells or too little hemoglobin. Pallor comes with tiredness, weakness, breathlessness on exertion, a fast heartbeat, headaches, dizziness and cold hands and feet.

• Iron deficiency anemia: the most common type, from heavy periods, pregnancy, low dietary iron, or slow bleeding from the gut (ulcers, NSAIDs, colon cancer). Cravings for ice (pica), brittle spoon-shaped nails and hair loss are clues.
• Vitamin B12 deficiency and folate deficiency: pale or slightly yellow skin, a sore red tongue, numbness, tingling and memory problems. Seen with pernicious anemia, vegan diets, metformin, acid-suppressing medicines and gut surgery.
• Anemia of chronic disease: with kidney disease, rheumatoid arthritis, infections and cancer.
• Hemolytic anemia: red cells destroyed early, causing pallor with jaundice and dark urine.
• Thalassemia and sickle cell disease: inherited.

Other medical causes

• Chronic kidney disease: reduced erythropoietin hormone causes anemia, with sallow skin.
• Hypothyroidism: pale, dry, cool skin with fatigue and weight gain.
• Leukemia and bone marrow disorders: pallor with bruising, bleeding, frequent infections, fever and bone pain. This is an important cause to exclude in children with unexplained pallor and bruising.
• Lead poisoning: in children in older housing, with anemia, belly pain and developmental problems.
• Malnutrition and eating disorders.

Not a medical problem

Fair genetics, little sun exposure and indoor lifestyles produce a naturally pale complexion with pink inner eyelids and no symptoms. Skin pigment conditions such as vitiligo cause white patches rather than overall pallor.

Pale skin in babies and children

Common causes include iron deficiency (especially in toddlers who drink a lot of cow's milk, over 24 oz or about 700 ml a day), viral infections and breath-holding spells. Seek urgent care if a pale child is floppy, unusually sleepy, breathing fast, has a fever with a rash, or has unexplained bruising.

How doctors find the cause

The doctor will ask how quickly the paleness appeared, about bleeding, periods, diet, medicines, weight loss and other symptoms, and examine the eyelids, nails, heart, belly and lymph nodes. Common tests:

• Complete blood count (CBC): confirms anemia and shows red cell size, which points to the cause
• Iron studies (ferritin), B12 and folate
• Reticulocyte count and tests for hemolysis
• Kidney, liver and thyroid function
• Stool tests or endoscopy to look for hidden bleeding in iron deficiency without an obvious cause, especially in men and women after menopause

Treatment

• Iron deficiency: iron tablets (often every other day improves absorption and tolerance), iron-rich foods, and finding and treating the source of iron loss. Intravenous iron if tablets fail.
• B12 deficiency: injections or high-dose tablets.
• Folate deficiency: folic acid tablets.
• Kidney disease: iron and erythropoiesis-stimulating agents.
• Hypothyroidism: thyroid hormone.
• Bleeding or severe anemia: blood transfusion in some cases.

Do not take iron supplements long-term without a confirmed deficiency. Excess iron is harmful, and accidental iron overdose is dangerous for young children, so keep tablets locked away.

Frequently asked questions

What does it mean when your skin is pale?

Pale skin can simply be your natural complexion. When it is a change, it most often means anemia, a lack of red blood cells, or reduced blood flow to the skin from fainting, low blood sugar, cold, shock or bleeding. Check your inner eyelids and nails, and see a doctor if you also feel tired or breathless.

What causes sudden pale skin?

Sudden pallor is usually caused by a faint, low blood sugar, fright, pain or cold. More serious causes include heavy bleeding, shock, heart attack and severe infection. Pale skin with chest pain, breathlessness, confusion or collapse is an emergency.

Is pale skin a sign of anemia?

Often, yes. Anemia reduces hemoglobin, the pigment that gives blood its red color, so the skin, lips, inner eyelids and nail beds look paler. Other signs are tiredness, breathlessness, a fast heartbeat and cold hands. A blood count confirms it.

What deficiency causes pale skin?

Iron deficiency is the most common, followed by vitamin B12 and folate deficiency. All reduce red blood cell production. B12 deficiency can also cause a slightly yellow tinge, a sore tongue and tingling in the hands and feet.

Why does my child look pale?

Common reasons include iron deficiency (often from drinking too much cow's milk), viral illnesses, tiredness and fair skin. See a doctor if paleness persists, and seek urgent care if a pale child is floppy, very sleepy, has a fever with rash, or bruises easily.