What causes pale skin?

Paleness may affect the face, lips, inside of the mouth, palms, or the lining of the eyelids. In some people it is easier to notice on areas that are normally lighter than surrounding skin. Cold, fright, pain, fainting, or temporary narrowing of blood vessels can make skin look pale for a short time.

A persistent change may occur when the blood carries less oxygen because of anaemia. Iron deficiency anaemia and vitamin B12 deficiency are possible causes; inherited blood conditions such as thalassaemia, sickle cell disease, or G6PD deficiency can also affect appearance. Pale skin alone does not identify one condition, so other symptoms and an examination matter.

Notice when the change began, whether it is general or limited to one area, and whether it varies with cold or activity. Record associated symptoms such as tiredness, breathlessness, dizziness, heavy periods, unusual bruising, or yellowing of the skin. A clinician may check your skin and order blood tests to look at red blood cells, iron, and vitamin levels. Do not start iron supplementation without advice, because the cause of anaemia should be established first.

Arrange prompt medical assessment if pallor persists, keeps returning, or comes with worsening tiredness, breathlessness, dizziness, bleeding, fever, or weight change. Seek emergency help for sudden marked paleness with fainting, confusion, severe breathing difficulty, chest pain, or signs of major bleeding.

Could anaemia or a vitamin deficiency explain this change? Which blood tests are appropriate? Could medicines, bleeding, or an inherited blood condition be involved? What symptoms should prompt urgent review?