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7 Causes of Pale Skin

How to tell when paleness is normal and when it’s a sign of serious conditions.
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Last updated September 9, 2021

Pale skin questionnaire

Use our free symptom checker to find out what's causing your pale skin.

Pale skin questionnaire

Use our free symptom checker to find out what's causing your pale skin.

Pale skin symptom checker

Pale skin occurs when the color drains from your face. It can happen when you’re frightened or shocked. When you’re scared, blood flow increases to your vital organs as part of the fight or flight response, while the blood vessels constrict (narrow) in other areas, like the surface of your skin. And when your skin gets less blood flow, your complexion turns pale.

Pale skin can be a sign that you have a shortage of normal red blood cells (anemia), which means that less oxygen is delivered to your body. This can be from a nutritional deficiency, blood loss, or a blood cancer like leukemia.  Other causes of pale skin include low blood pressure or infection.

Of course, some people naturally have pale skin. It’s probably genetic and not a cause for concern.

If you have other symptoms along with pale skin—such as fatigue, unexplained weight loss, or you bruise more easily—you should call your doctor.

Causes

1. Iron deficiency anemia

Symptoms

People with anemia have a shortage of healthy red blood cells, which carry oxygen to the body’s tissues. One common form of anemia is iron deficiency anemia, which is caused by low iron levels. It can occur when people lose blood over time, such as through stomach or intestinal bleeding caused by conditions like ulcers. Women who experience heavy menstrual bleeding may also develop iron deficiency anemia.

Iron deficiency anemia can become more severe over time. It can lead to heart problems and complications in pregnancy.

Your doctor may recommend iron supplements for mild iron deficiency anemia. If the condition is severe, you may need an iron infusion or blood transfusion. If your doctor suspects that your symptoms are caused by internal bleeding, you may need further testing to locate the source of the bleeding.

What causes iron deficiency anemia?

“Iron deficiency anemia can occur when someone has gastrointestinal bleeding from their stomach or intestines.  Pale skin could actually be one of the first signs, since blood in your stools may not be visible to the naked eye; doctors refer to this as ‘occult blood.’”—Dr. Anne Jacobsen

2. Respiratory infections

Symptoms

  • Cough
  • Runny nose
  • Congestion
  • Fever and chills
  • Fatigue
  • Pale skin

Respiratory infections include conditions like influenza (the flu), throat infection, and the common cold. When you have a respiratory illness, the blood vessels in your skin constrict so your body can redirect blood flow to treat the infection. This makes you look pale.

Respiratory infections can become dangerous if your oxygen levels drop too far below the normal range. Rest can usually help you recover from a viral infection, but you should see your doctor if you have trouble breathing or your symptoms don’t get better. You may need to take antibiotics or antiviral medication or receive oxygen therapy.

Getting the flu vaccine every year can minimize your risk of developing serious symptoms like low oxygen.

Pale skin questionnaire

Use our free symptom checker to find out what's causing your pale skin.

Pale skin symptom checker

3. Folate deficiency

Symptoms

  • Pale skin
  • Fatigue
  • Decreased energy
  • Trouble breathing

Folate deficiency is a shortage of vitamin B9 (folate). This vitamin is needed to make red blood cells, which carry oxygen throughout the body. Low folate levels lead to a shortage of healthy red blood cells, or anemia.

A poor diet can lead to this vitamin deficiency, as can alcoholism and some medications. Pregnant women are more likely to develop a folate deficiency because a growing fetus needs a lot of folate for development. This is why pregnant women are advised to take a daily supplement containing folic acid (a type of folate used in supplements.)

Folate deficiency can mimic other disorders like hypothyroidism or aplastic anemia, so it’s important to see a doctor right away to rule those out. If a blood test shows you’re low in folate, your doctor may recommend taking folic acid supplements.

4. Hypothyroidism

Symptoms

The thyroid is a gland in your neck that makes hormones to help control your body’s metabolism. Hypothyroidism occurs when the thyroid doesn’t produce enough of these hormones. This can cause skin changes, including dryness or pale skin.

Hypothyroidism has many causes. The most common cause is Hashimoto’s thyroiditis, an autoimmune condition that causes the immune system to attack the thyroid gland. Radiation therapy and certain medications (such as lithium) can also cause hypothyroidism. Some women develop the condition during or after pregnancy.

When untreated, hypothyroidism can cause complications such as heart problems and infertility. Pregnant women should see their doctor immediately if they have signs of hypothyroidism because the disease can harm the fetus.

Treatment varies depending on the underlying cause, though many people will need to take medication that contains synthetic thyroid hormones.

How is pale skin diagnosed in darker complexions?

"Sometimes pale skin isn’t noticeable in patients with darker complexions until the doctor checks inside the patient’s mouth or examines the insides of their eyelids." —Dr. Jacobsen

5. Vitiligo

Symptoms

  • Pale or white patches on the skin
  • Premature whitening or graying of hair

Vitiligo is when white patches develop on the skin because of a loss of color (pigment) in these areas.

It’s caused by a problem with the pigment-producing cells, called melanocytes. The body’s immune system attacks them. About 20% to 30% of people who get it have a close relative who has it. It is considered an autoimmune response and tends to occur in people with other autoimmune diseases like Hashimoto’s.

Vitiligo can also be caused by skin trauma, such as a severe sunburn.

Vitiligo usually appears on the hands and face first and may spread over time. Pale patches of skin may be the only symptom. Sometimes, it goes away on its own. If it doesn’t, see your doctor. Treatments such as medicated creams and light therapy may be recommended to restore skin color.

6. Blood cancers

Symptoms

Pale skin can be a sign of blood cancers such as leukemia, multiple myeloma, and lymphoma. It occurs because these diseases cause problems with the production of red blood cells. So people may develop anemia, which makes them look pale.

Symptoms of blood cancers can mimic symptoms of less serious conditions, such as the flu, exhaustion, or just feeling run down. If your recovery is taking longer than expected after a flu-like illness, or if you have unusual bleeding or bruising, see your doctor.

Treatment for blood cancer may include medications, chemotherapy, radiation therapy, stem cell transplantation, and surgery.

Pale skin questionnaire

Use our free symptom checker to find out what's causing your pale skin.

Pale skin symptom checker

7. Sepsis

Symptoms

Sepsis is your body’s extreme response to a bacterial infection such as pneumonia or appendicitis. Skin can appear pale, particularly when sepsis is complicated by shock or severely low blood pressure. People with weakened immune systems or chronic health problems may be more likely to develop sepsis when they become ill.

Sepsis is a medical emergency and you should go to the ER. Doctors will perform tests to find the source of infection and treat you with intravenous antibiotics.

Other possible causes

Here are other conditions that can cause pale skin:

  • Chronic diseases such as cystic fibrosis, heart or lung problems, or other types of cancers.
  • A blocked artery in your leg (in this case you’d have pale skin only affecting that area).
  • Anxiety or nervousness, though bouts of pale skin will be brief and usually improve quickly without treatment.

When to call the doctor

It’s important to monitor your pale skin and call your doctor if you have pale skin and:

  • Abnormal or increased bleeding or bruising
  • Exhaustion or fatigue
  • Dizzy spells
  • Muscle weakness

Should I go to the ER for pale skin?

You should go to the ER if you have any of these signs of a more serious problem:

  • Chest pain
  • Difficulty breathing
  • Fainting or losing consciousness
  • Rapid heart rate
  • Low blood pressure
  • Blood in your vomit or stools
  • Confusion

Treatments

At-home care

  • Eat a balanced diet that includes a variety of fruits and vegetables, including dark leafy greens, legumes (beans), and beef.
  • Limit alcohol intake.
  • Ask your doctor if you need to take a vitamin supplement, especially if you’re pregnant or trying to become pregnant.

Preventive care tip

"Make sure you keep appointments for annual physical exams with your primary care doctor and complete recommended tests. Routine blood work and screening tests like a colonoscopy can catch some of these conditions before you develop symptoms."—Dr. Jacobsen

Other treatment options

  • Vitamin or iron supplements
  • Medication
  • Blood transfusion
  • Cancer treatments such as chemotherapy and radiation therapy
  • Additional treatment based on specific diagnosis
Share your story
Dr. Jacobsen is a board-certified Emergency Medicine physician and writer for Buoy Health. She received her undergraduate degrees in Chemistry and Biology from Macalester College (2006) and graduated from the University of Kansas School of Medicine (2010). She completed an Emergency Medicine residency program at the University of Missouri-Kansas City (2013). She practices community Emergency Medic...
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