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.

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

• Fatigue

• Feeling mildly light-headed

• Feeling unusually cold

• Low energy level

• Mild shortness of breath with exertion that goes away with rest

• Sluggishness

• Sweating

• Tiring easily

Other symptoms that may occur with paleness vary depending on the underlying cause:

• Pale-colored hair and eyes

• Poor vision

• Sensitivity to cold

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

• Confusion; drowsiness; clumsiness; memory loss; lethargy; or trouble speaking, seeing or hearing

• Difficulty standing or walking

• Disorientation

• 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

• Vertigo (severe dizziness) and syncope (fainting) caused by a lack of oxygen in the brain

• Vomiting blood

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.

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:

• Alcoholism

• Autoimmune diseases such as lupus

• 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

• Cancer and its treatments, including chemotherapy and radiation therapy

• Chronic diseases, such as cancer, celiac disease, and kidney disease, which can hinder the body’s production of red blood cells

• Hemolytic anemia or sickle cell disease, in which the body destroys old red blood cells faster than it produces new ones

• 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

• Pregnancy

• Vitamin B₁₂ deficiency (pernicious anemia), aplastic anemia, or a low level of the hormone erythropoietin, which impair the body’s normal production of red blood cells

• Blood clots, such as arterial thrombosis and pulmonary embolism

• Cardiovascular diseases and conditions, such as heart attack and heart failure

• Dehydration

• Exposure to cold temperatures, hypothermia, or frostbite

• Fever and infectious diseases, such as pneumonia, food poisoning, influenza, pelvic inflammatory disease, and peritonitis

• 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)

• Respiratory diseases and conditions, such as chronic obstructive pulmonary disease (COPD), respiratory failure, pulmonary edema, asthma attack, croup, and epiglottitis

• Shock

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)

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:

• Coma

• 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

• Falls

• Gangrene and amputation of extremities

• Heart problems, including cardiac arrhythmias and congestive heart failure

• Hypotension (low blood pressure)

• Hypovolemic shock

• Impaired growth and development in children

• Organ dysfunction

• Severe vision problems or blindness