Pallor – Causes of Pale Skin or Paleness
What Is Paleness?
Paleness (pallor in Latin) is abnormal loss of color from normal skin or mucous membranes due to reduced amount of the blood in the skin arteries.
Paleness should be distinguished from other causes of prominent white skin:
- Fair skin is genetically determined skin hue with low concentration of skin pigment (melanin) in the skin. This skin hue is common in people in north European countries (Germany, Great Britain, Ireland, Scandinavian countries).
- Absence of skin tan from sun avoidance.
- Myxedema (in hypothyroidism) – swelling of under-skin tissues causes pale appearance of the skin.
- Albinism is a rare genetic disorder with partial or complete lack of melanin in the skin, hair and iris of the eye. Affected persons have white skin and hair, and red iris.
- Vitiligo is a patchy loss of skin color due to destruction of pigment cells (melanocytes) from an unknown cause.
Everyday Causes of Paleness
Paleness does not always mean you are ill.
- When exposed to low environmental temperature, your face, palms or other body parts may become pale because of narrowing (constriction) of the small skin arteries as part of a body’s heat-saving process.
- When you keep your arms or legs above the level of the heart for a minute, they may become pale (and numb or tingling), since the power of the heart can not efficiently pump the blood into the limbs against the force of gravitation.
- Skipped meal and resulting drop of glucose blood level, or dehydration, may trigger adrenalin release and constriction of your skin arteries.
- In exertion or fear, blood is redirected from the skin to muscle arteries. Your skin may remain pale for several minutes after exertion.
Health disorders, causing sudden paleness (within minutes to hours) all over the body:
- Orthostatic hypotension – temporary fall of blood pressure after standing up after prolonged sitting or lying.
- Stomach upset from wrong food combination, alcohol or food poisoning
- Dehydration from insufficient drinking, excessive sweating, vomiting, diarrhea
- Acute infection (usually with fever)
- Fainting (vasovagal syncope) due to strong pain, emotions, heat or unpleasant sensations
- Motion sickness
- Allergy to drugs
- Rapid stomach emptying (dumping syndrome)
- Heat stroke
- Heart failure due to heart attack, arrhythmia, infective endocarditis or other heart disorder, when the heart can not efficiently pump the blood into the circulation
- Low blood sugar (hypoglycemia), common in insulin-dependent diabetics after an exercise, skipped meal or insulin overdose
- Blood loss due to external or internal bleeding (in car accidents, shooting or stitch injuries), heavy menstrual bleeding, surgery
- Shock – a sudden, deep fall of blood pressure – due to poisoning, severe infection, burns, severe blood loss
- Side effect of medications:
- warfarin, corticosteroids, aspirin and other anti-rheumatic drugs may cause intestinal bleeding
- iron poisoning
- Drug overdose: amphetamine (speed), cocaine
- Chemical poisoning (pesticides), plant poisoning (Atropa belladonna)
Sudden Paleness in Limbs
Health disorders, causing sudden paleness in limbs:
- Raynaud’s disease and Raynaud’s phenomenon caused by exposure to cold, ergotamin, etc.
- Chilblains or frostbite
- Acute arterial occlusion
- Limb swelling after injury or surgery (compartment syndrome)
Long Lasting Paleness
Paleness lasting from few weeks to several years and affecting the whole body may result from:
- Low blood pressure, insufficient to keep small skin arteries open
- Anemia due to iron or vitamin B12 and folate deficiency due to
- low intake: vegetarians, irregular diet, starvation, alcoholism
- impaired absorption: Crohn’s or celiac disease
- intestinal parasites
- intestinal bleeding: colorectal cancer, ulcerative colitis
- heavy menstrual bleeding
- drugs phenytoin and methotrexate
- chronic kidney disease
- cancer in advanced stage
- chronic hepatitis or liver cirrhosis
- Chronic heart failure after heart attack, heart valve disorders, etc.
- Side effect of medications:
- warfarin, aspirin, ibuprofen, naproxen, corticosteroids may cause intestinal bleeding
- iron poisoning
- Drug abuse: amphetamine (speed), cocaine
- Thrombosis and other blood clotting disorders
- Leukemia, lymphoma, Hodgkin disease
- Hypopituitarism – impaired production of pituitary hormones, mainly due to pituitary adenoma
Long Lasting Paleness in Limbs
- Chronic arterial occlusion
- Carpal tunnel syndrome
Paleness in Children
Disorders, commonly or mainly causing paleness in children:
- Stress from travel
- Childhood diseases with fever
- Iron deficiency anemia
- Malnutrition due to starvation or lack of proteins in the diet
- Rheumatic fever
- Congenital heart disorders
- Cystic fibrosis
- Genetic metabolic disorders: phenylketonuria
When to See a Doctor?
If you have pale skin, visit a doctor, if you also have:
- Repeated unexplained attacks of nausea, vomiting, diarrhea, fainting, muscular cramps
- Unexplained fever
- Blood in the stool or heavy menstrual bleeding
- Chest pain
- Painful limbs, fingers or toes
- Unintended weight loss
- Prolonged diarrhea
- Weakness, tiredness
- Started new medication
Which Tests Can You Expect?
You can expect a doctor will ask you when did paleness appear, is it present all the time, which parts of your body affects, and what other symptoms you might have (check patient’s medical history form).
During physical examination, a doctor will check the color of your skin and mucous membranes in your mouth and eyes, size of the thyroid and liver and arterial pulse on your limbs, listen the heart and perform basic neurological examination. After that, some of the flowing tests might be needed to find a diagnosis:
- Blood tests to check white and red blood cells, coagulation factors, levels of iron, hemoglobin, vitamin B12 and folate, hepatic panel
- Fasting blood glucose
- Stool test for occult blood
- Urine tests for kidney disorders
- Thyroid hormone level
- Upper endoscopy when bleeding from the stomach or duodenum is suspected; colonoscopy in suspected bleeding from the colon
- ECG or X-ray of the heart
- Patien’ts Medical History Form
- Tingling and Numbness
- Itchy Skin
- Types of Skin Rashes