Pallor

Overview

Pallor is an abnormal paleness or loss of the usual color of the skin. It is often most noticeable in areas where blood vessels are close to the surface, such as the inside of the lower eyelids, the lips, the palms, and the nail beds, which is why these are useful places to check. Pallor is a sign rather than a disease, and it can be mild and harmless or a clue to an underlying problem.

Skin gets much of its color from blood flowing through tiny vessels and from red blood cells. When blood flow to the skin is reduced, such as in cold or fright, or when there are fewer red blood cells, as in anemia, the skin looks pale. Sudden pallor with weakness, fainting, or signs of bleeding can indicate a serious condition needing urgent care.

Because natural skin tone varies so much between people, pallor is judged less by overall complexion and more by a change from a person's usual color, and by looking at areas where blood shows through thin tissue. The inside of the lower eyelids, the lips, the gums, the palms, and the nail beds are the most reliable places to check. A noticeable loss of the normal pink color in these areas is a more meaningful sign than simply having fair skin.

Common Causes

Pallor usually reflects reduced blood flow to the skin or a drop in red blood cells:

• Anemia: A common cause, including iron-deficiency anemia, where too few healthy red blood cells reduce color and oxygen delivery.
• Cold exposure: Blood vessels in the skin tighten, causing temporary paleness.
• Fainting or near-fainting: A sudden drop in blood flow makes the skin pale.
• Blood loss: From injury, heavy periods, or internal bleeding.
• Low blood sugar or shock: Reduce circulation to the skin.
• Chronic illness or genetics: Some people are naturally pale, and certain long-term conditions cause pallor.

Pallor of the inner eyelids and palms is more telling than overall skin tone, which varies naturally between people.

Associated Symptoms

The symptoms accompanying pallor help reveal its cause and seriousness:

• Fatigue, weakness, or feeling run down
• Shortness of breath, especially with activity
• Dizziness, lightheadedness, or fainting
• Fast or pounding heartbeat
• Cold hands and feet
• Headache or trouble concentrating

Pallor that comes on suddenly with fainting, chest pain, fast breathing, confusion, or signs of bleeding (such as black stools or vomiting blood) is a warning sign of significant blood loss or shock and needs emergency care.

Diagnosis & Evaluation

A doctor will look at areas where pallor shows best, check vital signs, and ask about fatigue, bleeding, diet, and other symptoms. Tests may include:

• Complete blood count (CBC): To check for anemia and how severe it is.
• Iron studies and vitamin levels: To find the cause of anemia, such as iron, vitamin B12, or folate deficiency.
• Tests for bleeding: Stool tests or other studies if internal blood loss is suspected.
• Additional tests: Based on suspected underlying conditions, such as thyroid or chronic disease.

These tests determine whether pallor reflects anemia, blood loss, or another condition that needs treatment.

Treatment & Management

Treatment depends on the cause of the pallor:

• Treating anemia: Iron supplements and iron-rich foods for iron deficiency; vitamin B12 or folate for those deficiencies; addressing the underlying cause.
• Stopping blood loss: Finding and treating the source, such as heavy periods or a bleeding ulcer.
• Warming up: For pallor from cold, warming gradually restores color.
• Treating low blood sugar: Eating or drinking something with sugar if hypoglycemia is the cause.
• Emergency care: For pallor from shock or severe bleeding, immediate medical treatment is needed.

Because pallor often points to anemia or blood loss, ongoing or unexplained paleness should be evaluated rather than ignored.

When to See a Doctor

See a doctor if you or someone else looks persistently pale, especially with fatigue, shortness of breath, dizziness, or a fast heartbeat, since these suggest anemia or another condition worth investigating.

Call emergency services right away if pallor comes on suddenly with fainting, chest pain, severe shortness of breath, confusion, cold clammy skin, or signs of bleeding such as vomiting blood or black, tarry stools. Sudden, severe paleness can indicate major blood loss or shock and needs immediate treatment.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Paleness.
2. MedlinePlus, U.S. National Library of Medicine. Paleness.
3. National Heart, Lung, and Blood Institute (NHLBI). Anemia.
4. American Society of Hematology. Anemia.