Pale and yellow skin: possible explanations

Paleness may affect the face, gums, palms or inside the eyelids. Yellowing of the skin or whites of the eyes is often called jaundice and can occur when bilirubin builds up. The two appearances may occur together for different reasons, including a blood-cell problem, liver or bile-flow problem, infection, or lighting that changes how skin looks. Anaemia, iron deficiency anaemia, vitamin B12 deficiency, Sickle Cell Disease and Thalassaemia are possible blood-related conditions, but skin colour cannot distinguish them. Yellow foods or lighting can sometimes alter appearance without true jaundice.

Check the whites of the eyes in natural light and note urine and stool colour, abdominal pain, itching, fever, nausea, tiredness or new medicines. A clinician may examine you and arrange blood tests.

Arrange medical advice for new yellowing, especially if it is spreading or the eyes are yellow. Avoid alcohol until you have been assessed, and do not stop prescribed medicine unless a clinician advises it. Bring a list of medicines, supplements and recent travel or illness. Eat and drink normally if you can, but do not start iron supplementation because of paleness alone.

Seek emergency help for yellowing with confusion, extreme sleepiness, severe abdominal pain, repeated vomiting, fainting, breathing difficulty, heavy bleeding or rapidly worsening weakness. Same-day assessment is appropriate for fever, very dark urine, very pale stools, or yellowing during pregnancy. A newborn with yellow skin needs medical advice promptly.

Ask whether the eyes and skin truly show jaundice, which blood or liver tests are needed, and whether any medicine or supplement could contribute. Ask how to monitor symptoms and which changes require emergency help.