Paleness (Pallor) – Causes of Pale Skin or Color

Paleness is not the same as a light or fair skin complexion. Also known as pallor, paleness refers to a condition in which the skin or the mucus membranes lose their normal pinkish color due an alteration of the circulating blood in the vessels supplying the skin. In contrast, light complexion is a normal condition in which the skin has genetically lower amounts of the brown skin pigment known as melanin.

Causes of Skin Whitening

Paleness is also different from some other abnormal skin conditions that result in whitish skin. Some such conditions are:

  • Albinism: Albinism is a genetic disorder that causes a total absence of melanin pigment in the skin, iris, and hair. This results in reddish iris, white skin and white hair in the affected individuals. Albinism is a rare disorder.
  • Vitiligo: Vitiligo is also a skin condition caused by loss of melanin. This disorders is due to a patchy destruction of melanocytes (skin cells that produce melanin), resulting in the formation of white patches in the skin. The cause of melanocyte destruction in vitiligo is not known.
  • Lack of skin tan: Light complexioned skin can also be due to lack of skin tan caused by avoidance of sunlight.

Causes of Paleness

A pale skin does not always indicate a disease or disorder. There are some normal conditions during which a person may display a pale skin. This is due to a change in the blood oxygenation or blood flow through the surface blood vessels and particularly from the red blood cells within the bloodstream.

Normally the red blood of color contributes to the skin color in both light and dark complexioned individuals. The redness may be more obvious with lighter skin complexions. However, when the blood flow is reduced of the blood oxygen levels drop then there is a change in the skin color which is viewed as paleness.

Low environmental temperature

In cold weather, our body tries to maintain the core temperature by reducing the amount of heat lost from the peripheral regions. This is achieved through constriction of blood vessels in the peripheral tissues (such as skin). The consequent reduction in blood supply to the skin causes it to appear pale.

Lack of food or water

A drop in the blood glucose level (such as that caused by fasting) or dehydration (caused by lack of adequate water intake or excessive sweating) can also cause paleness.

Certain Emotions

Emotions like fear is an intense emotion that results in shunting of the blood from the periphery to the muscles. This can cause one to go “pale with fear”.

Physical exertion

Physical exertion also results in a redirection of the blood flow from the periphery to the active muscles. This can cause paleness initially but as the core body temperature rises then there is usually some flushing.

Sudden or acute paleness

Certain health disorders can cause skin paleness within a few minutes or hours. Some of the abnormal causes of sudden paleness that affects the entire skin surface include:

  • A temporary fall in blood pressure caused by suddenly standing up after lying down or sitting for a long time (technically referred to as orthostatic hypotension).
  • An upset stomach caused by consumption of contaminated food or alcohol.
  • Fever with an infection.
  • Severe pain, strong emotions, excessive heat and very unpleasant sensations that lead to fainting (also known as vasovagal syncope).
  • Motion sickness
  • Migraines
  • Drug allergy
  • Dumping syndrome or rapid emptying of the stomach.
  • Heat stroke
  • Heart failure caused by a variety of heart disorders such as a heart attack.
  • Hypothermia or abnormally low body temperture.
  • Hypoglycemia or low blood sugar caused by diabetes, insulin overdose or fasting.
  • Hemorrhage or blood loss caused by both external and internal bleeding (such as in heavy menstruation, surgery, and accidents).
  • Shock caused by various factors, such as burns, severe blood loss, infections and poisoning.
  • Side effects of drugs such as corticosteroids, anti-rheumatic drugs, aspirin, and warfarin.
  • Poisoning (for example, iron poisoning, pesticide poisoning, and plant poisoning).
  • Overdose of prescription drugs like sedatives and opioid painkillers or illlicit drugs like cocaine or amphetamine.
  • Death

Sudden or acute paleness in the limbs

Some conditions or health disorders can cause a sudden paleness of the skin on the hands and the feet without affecting the rest of the body. Such disorders include:

  • Frostbite (also known as chilblains)
  • Raynaud’s disease
  • Acute arterial occlusion (blocked artery) usually with a clot.
  • Swelling of arms and legs after surgery or injury.

Chronic paleness

Paleness can also last for a long time (several weeks to years). Such long-lasting paleness can be caused by the following conditions:

  • Anemia caused by a variety of conditions, such as vitamin B12 deficiency, folate deficiency, iron deficiency, impaired intestinal absorption, heavy menstruation, chronic kidney diseases, hemolysis, internal bleeding disorders, advanced cancer, cirrhosis of liver, and pregnancy.
  • Chronic heart diseases
  • Hypertensive disorders
  • Low blood pressure
  • Cocaine and amphetamine abuse
  • Iron-overload poisoning
  • Clotting disorders
  • Hypopituitarism
  • Hodgkin disease, lymphoma and leukemia

Read more on signs of anemia.

Chronic paleness in limbs

Conditions that can result in long-lasting paleness in the arms and legs without affecting the rest of the body includes:

  • Carpal tunnel syndrome
  • Chronic arterial occlusion
  • Acromegaly

Paleness in children

Some conditions can cause paleness either specifically or more commonly in children. Such disorders include:

  • Fever alongside other childhood diseases
  • Anemia caused by iron deficiency
  • Dehydration
  • Malnutrition
  • Fatigue
  • Cystic fibrosis
  • Phenylketonuria
  • Congenital heart disorders
  • Rheumatic fever

When to seek medical attention?

As described above, paleness of the skin could result from a variety of conditions. Some of these conditions are normal and physiologic, whereas others are abnormal and pathologic. Some cause only temporary and acute paleness, whereas others cause long-term or chronic paleness. Some causes affect the limbs, whereas others may involve other body regions. Children are more susceptible to certain causes.

Medical attention should be sought if the following symptoms arise alongside a pale skin:

  • Unexplained fever
  • Chest pain
  • Difficulty¬† breathing
  • Nausea
  • Vomiting or diarrhea
  • Abdominal cramps
  • Fainting
  • Blood in the stool
  • Abnormal vaginal bleeding
  • Pain in the fingers, toes, hands and feet
  • Unexplained loss of body weight

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