Pale skin (pallor)

Category: Skin, Hair & Nails · All skin symptoms

What it can feel like

Pale skin (pallor) means the skin, lips, nail beds and inner eyelids look paler than normal. In most cases it reflects a reduced blood count (anaemia); briefly, it also occurs with shock, cold or fainting, when blood is diverted from the skin. Comparing with your normal colour — and with family members — helps judge it.

Possible causes

A symptom can have many causes, and most are not serious. The lists below group conditions this symptom can be associated with — common causes first. They are possibilities to discuss with a clinician, not a diagnosis.

Common causes

Pallor can be associated with iron deficiency (the commonest cause worldwide, from diet, blood loss including heavy periods, or poor absorption), vitamin B12 or folate deficiency, and chronic diseases suppressing blood production.

Other possible causes

Pallor can also be associated with acute blood loss, conditions destroying red cells, kidney failure, an underactive thyroid, and bone-marrow problems — particularly when it develops quickly or arrives with breathlessness, chest pain or severe fatigue.

Red flags — when to seek help promptly

Pallor with breathlessness, chest pain or a racing heartbeat — urgent
Pallor with black stools, vomiting blood or obvious bleeding
Pallor developing rapidly over days
Pallor with yellowing of the eyes and dark urine
Pallor in a baby or child who is listless and not feeding

What a clinician may do

A clinician will examine the eyelids, lips and palms, check pulse and blood pressure, and arrange a blood count with iron studies and B12/folate levels. The cause hunt then follows the type of anaemia — dietary history, periods, bowels and medicines are all part of it.

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Frequently asked questions

Where do doctors look for pallor?

At the conjunctiva inside the lower eyelid, the lips, the nail beds and the palm creases — places where skin pigment interferes least with the colour of blood. It is less reliable in the face itself, which is why a 'pale face' is checked at the eyelid before conclusions are drawn.

Can you be iron-deficient without anaemia?

Yes — iron stores empty before the blood count falls, and low stores alone can cause fatigue, hair shedding, restless legs and mouth sores. Ferritin (the store marker) is checked alongside the count when deficiency is suspected.

Related symptoms — Skin, Hair & Nails

A mole that has changed A new lump under the skin A sore that does not heal Dry skin Easy bruising Flaky scalp (dandruff)

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Please note: This page is educational information about a symptom. A symptom alone cannot diagnose any condition, and the causes listed here are possibilities, not a diagnosis. If you are worried about a symptom — especially one that is new, severe, getting worse or not going away — please see your own clinician, who can examine you and arrange tests. In an emergency, call your local emergency number.