What is paleness?
Paleness, or pallor, is lighter than normal coloration of the skin. It can occur on the skin of the face and body, on the nails, or on the mucous membranes. Mucous membranes line various parts of the body, including the eyes, nose and mouth. Paleness can occur all over or only on certain areas of the body, such as the face and hands. Paleness can also appear in spots or patches.
Paleness can be caused by a variety of underlying diseases, disorders or conditions, ranging in severity from a temporary, relatively benign condition to one that is serious or even life threatening. Depending on the underlying cause, paleness can last a few seconds to weeks and months or longer.
Sudden paleness that fades within a few minutes, such as a person looking white as a sheet, could be due to sudden emotional distress, low blood sugar (hypoglycemia), or vasovagal syncope, which commonly causes fainting. In all of these situations, there has been an interruption of the normal flow of fresh, oxygenated blood to the tissues.
Overall paleness may be due to inheriting generally light skin or a form of albinism. Albinism is an inability to produce and distribute normal amounts of melanin, a skin pigment, resulting in very pale skin, eyes and hair. Paleness can also be caused by environmental and dietary factors, such as cold temperatures, frostbite, dehydration, scurvy, or lack of sun exposure. Various diseases, including anemia, and certain medications or illicit drugs can also cause ongoing paleness. Anemia itself is caused by a wide variety of diseases, disorders and conditions and affects more than three million people in the United States (Source: OWH).
Paleness may occur by itself or, depending on the underlying cause, may occur with other symptoms, such as dizziness, fainting, heart palpitations, shortness of breath, weakness, or skin throbbing, aching, or numbness.
Complications of severe anemia and other serious causes of paleness, such as heart failure or chronic obstructive pulmonary disease, can be serious and life threatening. Seek prompt medical care if you have symptoms of anemia, such as mild dizziness or weakness, or if you have a low energy level and tire easily. Prompt diagnosis and treatment of anemia and its underlying cause reduces the risk of serious complications.
Seek immediate medical care (call 911) if you, or someone you are with, have a sudden change in alertness or consciousness, severe shortness of breath, chest pain, or uncontrolled bleeding, such as bleeding heavily from the rectum, bloody stools, or vomiting blood.
What other symptoms might occur with paleness?
Paleness may occur alone or with other symptoms. When you have unexplained paleness or skin color changes that concern you, it is important to pay close attention to any other symptoms you may have. This will help you and your licensed medical professional pinpoint and treat the underlying cause.
When general paleness appears gradually over time (or suddenly in some cases), it may be the result of anemia, a condition in which there are too few red blood cells in the blood.
Other symptoms of mild to moderate anemia that may occur with paleness
When anemia is mild or develops slowly, symptoms may not be noticeable at first because the body can adjust to the slow decline in red blood cells. Symptoms can also be mild or vague and include:
- Difficulties with memory and concentration
- Feeling mildly light-headed
- Feeling unusually cold
- Low energy level
- Mild shortness of breath with exertion that goes away with rest
- Tiring easily
Other symptoms that may occur with paleness
Other symptoms that may occur with paleness vary depending on the underlying cause:
Pale-colored hair and eyes
Sensitivity to cold
Serious symptoms that might indicate a life-threatening condition
Anemia is a leading cause of paleness. When anemia is severe or develops quickly, symptoms are more serious because the body cannot adjust to the rapid decrease in blood pressure and decline in oxygen delivery to the cells. Left untreated, this can result in shock and death. Other serious conditions that cause pale skin include heart attack, pulmonary edema, pneumonia, and respiratory failure. Seek immediate medical care (call 911) if you, or someone you are with, have any of the following symptoms:
- Abnormal pupil size or nonreactivity to light
- Bloody or black, tarry stools (melena)
- Bluish coloration of the lips or fingernails (cyanosis)
- Chest pain, tightness, or pressure
- Cold, clammy skin
- Difficulty standing or walking
- Exposure to cold temperatures, possible hypothermia, and tingling, throbbing, aching, numbness or hardness where the skin is pale due to frostbite
- Heavy, uncontrolled bleeding or hemorrhage
- Rapid heart rate (tachycardia) or palpitations due to a lack of oxygen delivered to the heart
- Respiratory or breathing problems, such as severe shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking
- Vomiting blood
What causes paleness?
Paleness can be caused by a variety of underlying diseases, disorders and conditions, including heart attack and respiratory conditions, such as emphysema, heart failure, acute asthma, and respiratory failure. Paleness can also be the result of cold temperatures, frostbite, dehydration, and use of certain medications or illicit drugs. When general paleness appears gradually over time, it may be caused by anemia, a condition in which there are too few red blood cells in the blood.
Causes of paleness due to anemia
Anemia is an abnormal condition in which there are a low number of red blood cells in the blood. Anemia can be caused by a variety of diseases, disorders or conditions including:
Bleeding or hemorrhage from heavy or long menstrual periods; cancers including uterine and colorectal cancer; blood clotting disorders; perforated peptic ulcer; complications of surgery or childbirth; ruptured aortic aneurysm or esophageal varices; or trauma, such as a pelvic fracture, spleen injury, or aortic rupture
Iron deficiency anemia and thalassemia, which cause a deficiency of hemoglobin, the oxygen-carrying part of the red blood cell
Medications, including antibiotics, anticoagulants or “blood thinners”, antiseizure medications, aspirin and other salicylate medications, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDS), ACE inhibitors, angiotensin receptor blockers (ARBs), levodopa, and medications for HIV/AIDS
Cardiovascular diseases and conditions, such as heart attack and heart failure
Exposure to cold temperatures, hypothermia, or frostbite
Hypoglycemia (low blood sugar)
Hypothyroidism (underactive thyroid)
Ingestion of certain medications and illicit drugs
Raynaud’s disease (spasms of small blood vessels of the fingers and toes, reducing blood circulation)
Other causes of paleness
Paleness can also be caused by a variety of other underlying diseases, disorders or conditions including:
- Albinism (inability to produce normal amounts of the pigment melanin, resulting in very pale skin, eyes and hair)
- Emotional shock such as fear, surprise or grief
- Hypopigmentation (decreased pigment production)
- Nausea and vomiting
- Normal light skin pigmentation
- Vasovagal response, which commonly causes fainting
- Vitiligo (acquired skin depigmentation)
Questions for diagnosing the cause of paleness
To diagnose the underlying cause of paleness, your doctor or licensed healthcare provider may ask you several questions about your symptoms. Providing complete answers to these questions will help your provider in diagnosing the cause of paleness:
When did the paleness first appear and in what area of the skin or body?
Do you have any other symptoms?
Have you had similar symptoms before?
Have you recently been exposed to very cold temperatures?
Have you recently experienced any kind of emotional shock, whether positive or negative?
What are the diseases and conditions in your medical history and what prescription medications, over-the-counter medications, dietary supplements, and herbal products are you taking?
Untreated anemia and some other underlying causes of paleness can lead to serious and life-threatening complications. Once the underlying cause of paleness is diagnosed, you can help minimize your risk of serious complications by following the treatment plan you and your healthcare professional design specifically for you. Complications of underlying causes of paleness include:
Damage to muscles, nerves and bones
Difficulty functioning in everyday life because of fatigue, shortness of breath, difficulty concentrating, and passing out
Embarrassment and stress
Gangrene and amputation of extremities
Impaired growth and development in children
Severe vision problems or blindness