Paleness

Unless pale skin is accompanied by pale lips, tongue, palms of the hands, inside of the mouth, and lining of the eyes, it is probably not a serious condition and does not require treatment.

General paleness affects the entire body. It is most easily seen on the face, lining of the eyes, inner mouth, and nails. Local paleness usually affects a single limb.

How easily paleness is diagnosed varies with skin color and the thickness and amount of blood vessels in the tissue under the skin. Sometimes it is only a lightening of skin color. Paleness may be difficult to detect in a dark-skinned person and is detected only in the eye and mouth lining.

Paleness may be the result of decreased blood supply to the skin. It can also be due to decreased number of red blood cells (anemia). Paleness of the skin is not the same as loss of pigment from the skin. Paleness is related to blood flow in the skin rather than deposit of melanin in the skin.

Paleness can be caused by:

• Anemia (blood loss, poor nutrition, or underlying disease)
• Problems with the circulatory system
• Shock
• Fainting
• Frostbite
• Low blood sugar
• Chronic (long-term) diseases including infection and cancer
• Certain medicines
• Certain vitamin deficiencies

Call your health care provider or 911 or the local emergency number if a person suddenly develops generalized paleness. Emergency action may be needed to maintain proper blood circulation.

Also call your provider if paleness is accompanied by shortness of breath, blood in the stool, or other unexplained symptoms.

Your provider will examine you and ask about your medical history and symptoms, including:

• Did the paleness develop suddenly?
• Did it happen after reminders of a traumatic event?
• Are you pale all over or only in one part of the body? If so, where?
• What other symptoms do you have? For example, do you have pain, shortness of breath, blood in the stool, or are you vomiting blood?
• Do you have a pale arm, hand, leg or foot, and cannot feel a pulse in the area?

Tests that may be ordered include:

• Extremity arteriography
• CBC (complete blood count)
• Blood differential
• Thyroid function tests
• Colonoscopy to check for bleeding in the large intestine

Treatment will depend on the cause of paleness.

Skin - pale or gray; Pallor

Schwarzenberger K, Callen JP. Dermatologic manifestations in patients with systemic disease. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 53.

Seller RH, Symons AB. Skin problems. In: Seller RH, Symons AB, eds. Differential Diagnosis of Common Complaints. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 29.

Updated by: Elika Hoss, MD, Assistant Professor of Dermatology, Mayo Clinic, Scottsdale, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.