Unianncd Caucasoid skin is pink owing to the red pigment oxyhaemoglohin in the capillary-venous plexuses of the superficial dermia. The contribution of haemoglobin to the complexion is influenced by the proportion which is oxygenated or reduced.

Pallor may be due to anaemia or to vasoconstriction, which may occur when subjects faint or are frightened. The observation by relatives or friends of increasing pallor may

Fig. 2.3 Abnormal coloration of the skin. H Phenothiazine-induced pigmentation, H Jaundice (by permission of M. Eastwood).

be an early feature of progressive anaemia. Examination of the mucous membranes may help to distinguish the pallor of anaemia from that of other causes.

Vasodilatation may produce a deceptive pink complexion even in the presence of anaemia. An unduly plethoric complexion may be seen in polycythacmia, some alcohol abusers with a pseudo-Cushing's syndrome and in Cushing's syndrome itself (see Fig. 2.8A, p. 32). The plethora of Cushing's syndrome is due to thinning of the skin with enhanced visibility of superficial blood vessels.

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