Paleness Assessment Questionnaire

Why: to determine if acute or chronic. Albinism is present at birth. Some causes of sudden acute paleness include fainting, shock, motion sickness, heart attack, heart rhythm problem, hypoglycemia (low blood sugar attack), severe gastroenteritis, leukemia or bleeding disorder.

Why: Generalised paleness of the skin suggests albinism, phenylketonuria, fainting, shock, motion sickness, heart attack, heart rhythm problems, hypoglycemia (low blood sugar attack), severe gastroenteritis, leukemia or bleeding disorder. Localised paleness suggests Raynaud's phenomenon, vitiligo, post-inflammatory hypopigmentation, pityriasis versicolor or exposure to certain substances that are toxic to pigment producing cells.

Why: e.g. stress, physical exertion, lack of sun exposure, normal genetic variation, motion sickness.

Why: e.g. physical trauma, illness, emotional stress, following the death of a relative, following sunburn.

Why: e.g. high humidity, Cushing's syndrome, prolonged administration of both topical or oral corticosteroids.

Why: pregnancy causes increased physiological requirements of iron and folate.

Why: e.g. vitiligo may be associated with diabetes mellitus, thyroiditis, pernicious anemia, Addison's disease or polyendocrine deficiency syndrome type 2; eczema and psoriasis may result in post inflammatory hypopigmentation (lack of pigment in the skin); Cushing's syndrome increases susceptibility to pityriasis versicolor; Many chronic diseases may cause anemia such as connective tissue disease, malignancy, thyroid disorders and Addison's disease; Raynaud's phenomenon may be associated with rheumatoid arthritis, lupus erythematosus, systemic sclerosis, polyarteritis nodosa, Buerger's disease, polycythaemia, leukemia, polymyositis and dermatomyositis.

Why: e.g. previous stomach or small bowel surgery can cause Vitamin B12 deficiency; any recent surgery can cause blood loss.

Why: e.g. aspirin, anti-inflammatory medications, corticosteroids and warfarin all increase the risk of blood loss from the gastrointestinal tract and thus iron deficiency anemia; phenytoin and methotrexate can reduce folate and thus cause anemia; chloramphenicol, anti-cancer drugs, sulphonamides can cause bone marrow failure and thus anemia; beta-blocker blood pressure medications and ergotamine can cause Raynaud's phenomenon.

Why: e.g. including vegetarianism, lack of red meat, animal products and green leafy vegetables - may indicate dietary deficiency of iron, folate or B12 as cause of anemia.

Why: Alcohol can cause anemia by several mechanisms e.g. Gastrointestinal blood loss due to esophageal varices or peptic ulcer; folate deficiency and sideroblastic anemia.

Why: e.g. albinism; vitiligo; individuals from families with an increased prevalence of thyroid disease and diabetes appear to be at an increased risk for developing vitiligo; Thallasaemia, Colorectal carcinoma, Sideroblastic anemia.

Why: e.g. lethargic, tired, shortness of breath, dizziness, chest pains, palpitations - may indicate if anemia is symptomatic or asymptomatic.

Why: i.e heavy periods with clotting and flooding - may indicate cause of chronic blood loss and thus anemia.

Why: e.g. episodic burning pain in upper abdomen below the ribs related to meals - may be cause of chronic blood loss and thus anemia.

Why: may be due to colorectal cancer or polyps, diverticular disease, hemorrhoids, angiodysplasia and thus be a cause of chronic blood loss and thus anemia.

Why: indicates bleeding from the upper gastrointestinal tract e.g. peptic ulcer or esophageal varices and thus be cause of anemia.

Why: e.g. intolerance to wheat, bloating, indigestion, diarrhea, bulky frothy stools - causes iron and folate deficiency and anemia due to malabsorption.

Why: e.g. recurrent attacks of loose stools, bloody diarrhea, mucous in stools - may be a cause of chronic blood loss and thus anemia.

Why: e.g. numbness, lack of co-ordination of movement and memory loss - may indicate pernicious anemia.

Why: e.g. milky white skin, white hair, blue eyes, photophobia (dislike of light).

Why: e.g. reduced pigmentation of the skin, hair and eyes. Mental retardation may develop if untreated.

Why: e.g. white or off-white patches of pigment loss are usually symmetrical and ring-shaped in outline. The areas enlarge peripherally. The initial areas of involvement often include the fingers, hands, face and genitalia. May also be associated with white or prematurely grey hair or patchy hair loss. Onset may be precipitated by physical trauma, illness, emotional stress, following the death of a relation or following sunburn.

Why: e.g. hypopigmentation (lack of skin pigment) of areas of skin that have been traumatized by chemicals, physical agents or after inflammatory skin conditions such as eczema.

Why: e.g. either brown patches on pale skin or white patches on tanned skin. Usually occurs on the trunk and the patches may coalesce. May also involve the neck, upper arms, face and groin. Occasionally skin may be mildly itchy.

Why: e.g. found primarily in Asia and Africa. Hypopigmented skin patches associated with loss of sensation, especially to touch or temperature. Nerves that supply the affected areas of skin are thickened and tender. Nerve involvement may cause muscle weakness and deformities of hands and feet.

Why: e.g. sequential discoloration of the digits from pallor to blueness to redness upon exposure to cold. When fingers become red they are painful.