While people tend to associate pallor with the face, it can also cause the nail beds to turn very light or white. The color change can likewise affect the lips, gums, and tongue. When a person appears pale, it may be because there is not enough oxygen-rich hemoglobin near the skin’s surface. Hemoglobin is a protein in red blood cells that transports oxygen, and several conditions can reduce hemoglobin levels. Paleness is different from low levels of pigment in the skin.
Some genetic conditions, such as albinism and vitiligo, affect the skin’s pigment. Pigmentation changes can also result from skin damage, such as from a burn or injury. In these cases, the body’s melanocytes, the cells that give the skin its pigment, are involved.
Below, we describe the most common causes of skin paleness.
Anemia refers to a group of conditions that prevent the blood from having enough healthy red cells. Red blood cells contain hemoglobin, which carries oxygen. Without enough hemoglobin and oxygen, the skin can turn pale.
Iron-deficiency anemia is the most common type, and it involves a person not having enough iron. This can occur when the body is unable to absorb iron correctly or when bleeding depletes iron levels. Some other types of anemia include:
- aplastic anemia, which occurs when the bone marrow stops making red blood cells
- hemolytic anemia, which involves red blood cells being destroyed in the spleen or bloodstream
- sickle cell anemia, which is genetic and involves problematic rigidity of the red blood cells
Certain diseases, including cancer, can cause anemia, and it can also develop after heavy bleeding. A person with anemia may feel exhausted and experience shortness of breath. Anemia requires medical treatment; anyone who suspects that they have it should see a doctor.
Any type of excessive bleeding can deplete the body’s iron stores and reduce hemoglobin levels, causing paleness. Bleeding that is severe enough to cause paleness warrants immediate medical attention. If the person is still actively bleeding, their life is in danger and they must receive emergency assistance. Some examples of bleeding that can cause paleness include:
- a very heavy menstrual period that soaks more than one pad per hour for more than 2 hours
- heavy postpartum bleeding
- gastrointestinal bleeding resulting from an injury or ulcer
- internal bleeding from a recent injury
- bleeding following surgery
Extreme malnourishment can make it difficult for the body to produce healthy blood cells. Vitamin-deficiency anemia can result when a person has insufficient levels of vitamin B-12, which is also called folate. Anyone with this type of anemia may become very pale and exhausted. A B-12 deficiency may occur when the gastrointestinal tract cannot absorb the vitamin correctly.
A doctor’s blood test can reveal whether a person has vitamin deficiencies. While vitamin supplements may help, some nutritional deficiencies result from problems with absorption, rather than a lack in the diet. Anyone who suspects that they have a vitamin deficiency should see a doctor for a diagnosis.
A wide range of infections can cause pallor.
One of the most serious is sepsis, a type of infection that can result from bacteria entering the bloodstream. If the bacteria damage red blood cells, it can cause a person to look pale. Sepsis is a medical emergency that usually requires a person to take antibiotics and stay in the hospital.
Paleness can also result from:
- infections such as the common cold or the flu
- a fever
- infection-related breathing problems that cause low blood oxygen levels
In some cases, fatigue — especially chronic fatigue — is a symptom of an underlying condition, such as anemia.
Breathing disorders make it difficult for a person to get enough oxygen, and this can result in paleness. Chronic obstructive pulmonary disease and lung cancer are two examples of these conditions. Acute breathing issues, such as those caused by an asthma attack or anaphylactic shock, can also deplete blood oxygen levels. In addition, some people develop a blue tinge to their skin called cyanosis. Breathing difficulties that are severe enough to cause paleness indicate that a person is not getting enough oxygen. It is important for people taking oxygen therapy to use it as their doctor has prescribed. Anyone experiencing an episode of acute breathing difficulty should receive medical attention.
Some rare genetic disorders affect red blood cells — or hemoglobin in particular — and cause chronic paleness. Usually, a person will be pale for their whole life.
One such condition is glucose-6-phosphate dehydrogenase deficiency (G6PD). This disorder almost always develops in males, and it causes red blood cells to break down prematurely, leading to hemolytic anemia. A person may be very pale, with yellowing around the eyes.
Many people with G6PD have specific triggers, including eating fava beans. Removing the trigger often treats the condition.
Certain cancers can cause paleness. For example, lung cancer can restrict a person’s ability to breathe and lead to oxygen deprivation. Also, leukemia affects the body’s ability to produce red blood cells, causing paleness and reducing blood oxygen levels.
When to see a doctor
When paleness is the only symptom that a person has, an urgent trip to the doctor is usually not necessary. If the pallor does not go away or it becomes worse, see a doctor within a few days. Contact a doctor when paleness occurs with:
- a high fever
- any fever in a newborn or infant
- symptoms of an infection, such as swollen lymph nodes or a swollen injury
- stomach pain
- yellowing of the skin or eyes
Seek emergency medical attention when paleness occurs:
- during or following an episode of bleeding
- with difficulty breathing, such as shortness of breath
- in an infant or newborn with a respiratory infection
A person with any skin tone can grow pale when they have too little hemoglobin or oxygen in their body. Paleness can sometimes be a symptom of a severe health issue. However, almost all causes of pallor are fully treatable, especially with prompt care. See a doctor for unexplained paleness, especially when there are accompanying symptoms.
- Blood / Hematology
- Nutrition / Diet