How to address pale skin

Paleness can be easier to see on the face, lips, inside the eyelids or palms than on other areas. It may follow cold, fear, faintness or reduced blood flow, but persistent pallor can occur with anaemia. Iron deficiency anaemia may also cause tiredness, headaches, breathlessness or a sore tongue.

Other possibilities include vitamin B12 deficiency, inherited blood conditions such as thalassaemia or sickle cell disease, and blood loss. Skin tone varies naturally, so compare with your usual colour and notice changes in the mouth, eyes and nails as well as the skin.

Make a note of when the change began, whether it is general or patchy, and any fatigue, dizziness, heavy menstrual bleeding, digestive symptoms or altered sensation. Eat regular varied meals, but do not take iron or other supplements without advice; excess iron can be harmful and the correct treatment depends on the cause.

A clinician may examine your skin and ask about diet, bleeding, medicines and family history. Blood tests can check haemoglobin, iron status and vitamin levels, with further tests guided by the findings.

Seek urgent help if pale skin appears with fainting, chest pain, severe breathlessness, confusion, heavy bleeding, blue lips or sudden weakness. Arrange prompt medical review for ongoing pallor, worsening tiredness, black stools, unusual bruising or a new change in someone with a known blood disorder.

What could explain this change in my usual colour? Do I need blood tests for anaemia, iron or vitamin B12? Could bleeding, diet or a medicine be contributing, and when should I expect a review?