PALLOR

Pallor refers to an abnormal paleness of the skin, which can be attributed to various clinical factors.When the lower eyelid is gently pulled down for inspection, the mucosal surface of the inner eyelid appears noticeably whiter or paler compared to the healthy pink-red color.

EXAMINATION OF PALLOR

I have seen many paces candidates after watching their favorite online tutorial stands far away from the patient and ask the patient to pull down their eyelid. While this may work in UK but in Asian centres it will put you at risk, a patient with scleroderma will have a tight eyelid which will be nearly impossible to evert, some patient may not understand your comment at all due to language barrier. Better go near the patient as his permission and gently evert one eyelid at a time.

Mechanism

In anemic patients, there is a deficiency of oxyhemoglobin, which is responsible for the normal red color of blood. As a result, capillaries and venules appear pale, leading to a similarly pale appearance of the conjunctiva.

The causes of pallor can be categorized as follows:

1. Genetic and Familial Factors: Certain hereditary conditions may lead to pallor, as seen in familial cases.
2. Environmental and Occupational Factors: Exposure to specific environments or occupations can contribute to pallor.
3. Medical Conditions:
   • Anemia: A deficiency in red blood cells or hemoglobin can cause pallor.
   • Vasomotor Responses: Conditions that affect blood vessel constriction can lead to a pale appearance.
   • Chronic Diseases: Conditions such as tuberculosis, nephritis, and cardiovascular diseases can also result in pallor.
   • Endocrine Disorders: Diseases affecting hormonal balance may contribute to skin color changes.
4. Skin and Mucosal Changes: Pallor can manifest in various forms, such as:
   • Habitual Pallor: Persistent paleness due to underlying health issues.
   • Progressive Pallor: A gradual increase in paleness, often associated with conditions like purpura or hemorrhage.
5. Other Factors:
   • Chronic Infections: Conditions like malaria can lead to pallor.
   • Skin Conditions: Certain dermatological issues may also cause changes in skin color.