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Skin color is determined by several factors, including the amount of blood flowing to your skin, your skin’s thickness, and the amount of melanin in your skin.

Paleness, also known as pallor, is an unusual lightness of skin color compared with your normal complexion. It’s different than having skin that’s naturally light.

Paleness is not a condition in and of itself.

It may be caused by reduced blood flow and oxygen or by a decreased number of red blood cells. It can be a manifestation of emotions such as fear [“pale as a ghost”], or it can be a symptom of serious medical conditions such as severe anemia, bloodstream infection, or frostbite.

Paleness can occur all over your skin or appear more localized. Localized paleness usually involves one limb. See a doctor if you have the sudden onset of generalized paleness or paleness of a limb.

Causes of paleness include:

• lack of sun exposure
• cold exposure and frostbite
• heat exhaustion
• shock, or decreased blood flow throughout the body
• hypoglycemia, or low blood sugar
• blockage in the artery of a limb
• bloodstream infection, such as sepsis
• anemia, which may be the result of:
  • rapid blood loss
  • nutritional deficiency
  • genetics
  • chronic conditions, including cancer
  • pregnancy

Anemia and paleness

In anemia, your body does not produce enough red blood cells. It’s one of the most common causes of paleness. Anemia can be acute with a sudden onset or chronic and develop slowly.

Acute anemia

Acute anemia is usually the result of rapid blood loss from trauma, surgery, or internal bleeding, often from your stomach or intestinal tract.

Chronic anemia

Heavy menstrual bleeding is a common cause of chronic anemia.

Chronic anemia can also be caused by a lack of iron, vitamin B12, or folate [folic acid] in your diet.

There are genetic causes of anemia, too. In conditions such as sickle cell disease and thalassemia, your body makes ineffective hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen.

Chronic anemia can also be caused by conditions such as chronic kidney failure or hypothyroidism. Certain cancers that affect your bones or bone marrow can also cause anemia due to poor production of blood cells over a period of weeks to months.

In addition to your skin, paleness may also be noted in the following areas:

• your fingernails
• your tongue
• mucous membranes inside your mouth
• inner membranes of your lower eyelids

Paleness in your inner eyelids is a telltale sign of anemia, regardless of race. It’s also considered a sensitive indicator of severe anemia.

Call a doctor right away if you suddenly develop generalized pallor. Paleness is considered a medical emergency when it’s accompanied by symptoms such as:

• fainting
• fever
• vomiting blood
• rectal bleeding
• abdominal pain

Other serious symptoms that require immediate medical attention include:

• a limb that’s pale or feels cold
• shortness of breath
• chest pain with sudden onset of paleness

If you have a sudden onset of paleness as well as severe symptoms — such as fainting, fever, and abdominal pain —head to the emergency room.

If you develop paleness and symptoms such as fatigue and mild shortness of breath, you can usually be seen in a doctor’s office and will not require emergency treatment.

Paleness, hypotension, and a weak, rapid pulse are signs that you’re seriously ill. Abdominal pain and tenderness might mean that internal bleeding is causing your pallor. If you experience any of these symptoms, a doctor may need to order additional tests right away to determine the underlying cause of your condition.

The doctor will review your symptoms and medical history, perform a physical exam, and check your heart rate and blood pressure.

Pallor can often be diagnosed by sight, but it can be hard to detect in people with dark complexions. If you have a darker complexion, your doctor may check your inner eyelids and mucous membranes for a loss of color.

The following tests are used to evaluate causes of paleness:

• Complete blood count [CBC]. The complete blood count helps evaluate if you have anemia or infection.
• Reticulocyte count. This blood test helps a doctor see how well your bone marrow is working.
• Fecal blood test. This test is used to check for the presence of blood in your stool, which may indicate intestinal bleeding.
• Thyroid function tests. This series of tests is used to check your thyroid hormone levels. A low-functioning thyroid can cause anemia.
• Kidney function tests. Because kidney failure can cause anemia, your doctor may order a blood urea nitrogen [BUN] or creatinine blood test to check how well your kidneys are working.
• Tests for nutrient deficiencies. Your doctor may order a serum iron, vitamin B12, or folic acid level test to see if a nutrient deficiency is causing the anemia.
• Noninvasive imaging tests. Depending on your medical history and physical exam, your doctor may perform a noninvasive imaging test such as a CT scan or an ultrasound. These tests allow your doctor to get a better look at the inside of your body. Your doctor will look at regions such as the head, neck, chest, or abdomen.
• Extremity arteriography. This X-ray test involves injecting dye into the artery of a limb to help the doctor see if there’s a blockage. Learn more about extremity arteriography.

Treatment depends on the cause of your pallor. Options can include:

• eating a nutrient-rich, balanced diet
• taking iron, vitamin B12, or folate supplements
• taking medication or getting treatment to manage ongoing medical conditions
• covering your hands or feet in warm water or a warm washcloth, if you have frostbite
• cooling off, hydrating, and getting out of constricting clothes or accessories, if you have heat exhaustion
• consuming glucose tablets, juice, or other fast-acting carbohydrates, if you have hypoglycemia
• lifestyle measures to improve poor circulation, such as:
  • avoiding or quitting smoking
  • avoiding alcohol
  • managing your blood sugar levels
  • managing your cholesterol levels
  • surgery, usually only in severe cases of acute blood loss or for treatment of arterial blockage

Having the correct diagnosis is key to timely and proper treatment.

The consequences of untreated paleness depend on the underlying cause. Acute cases of pallor require immediate medical attention. Ongoing paleness can often be treated with medication.