Melasma linked to birth control pill

DEAR DR. GOTT: I have had melasma on my upper lip for about five years now. Looking online, I read that birth control pills could be associated with this condition. Sun exposure makes it worse. I am 44, and up until recently had been on birth control pills since I was 18. I stopped taking the pill to see if it was the culprit behind a consistent, unexplained elevated liver enzyme (I have never used alcohol).

Two years ago I had a series of microdermabrasion treatments on my face, which was performed at a plastic surgeon’s office. This did remove the melasma, but only for a short time. I am aware that using fade creams can result in the melasma returning in a darker form.
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