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.

I live in Bermuda, where it is difficult to avoid the sun. I apply 60 SPF sunscreen every day. I started taking grapefruit seed extract five weeks ago, as I read this could help remove the melasma. It appears to have faded somewhat but is still lingering. Should I continue with the grapefruit seed extract, or can you suggest a better treatment remedy?

DEAR READER: Melasma is a common skin condition. It can affect anyone, but is most common in young women with brownish skin tones. It is most often associated with estrogen and progesterone, and may result from pregnancy, the use of oral contraceptive pills or hormone replacement therapy (HRT).The only symptom is a uniform, brown discoloration, typically on the cheeks, nose, forehead or upper lip. It is typically symmetrical, affecting both sides of the face equally.The discoloration often fades over several months following discontinuation of the HRT, birth control or delivery. Treatment can include creams with a combination of tretinoin, kojic acid, and azelaic acid, chemical peels and topical steroids. Severe cases may benefit from laser treatments. Using sunscreen daily may prevent the condition or keep it from worsening.I suspect that your birth control pills are to blame. Depending on how recently you stopped the pill, you may still have some months before the fading is completed. They may be to blame for your elevated liver enzymes as well. Potential side effects from oral contraceptives include cholestasis, hepatic vein thrombosis, Budd-Chiari syndrome and veno-occlusive disease. These all affect the liver.Cholestasis is a reduced secretion or flow of bile. Hepatic vein thrombosis is characterized by blood clots that form within the large veins within the liver and the inferior vena cava (which drains blood out of the liver). Budd-Chiari syndrome occurs when the hepatic vein thrombosis results in an enlarged liver, abdominal pain, ascites (fluid within the abdomen) and liver failure. Veno-occlusive disease is thrombosis of the liver's small blood vessels.I am not familiar with the grapefruit seed extract, so I cannot tell you if it will work or not. If you have been off the birth control pills since starting the supplement, this may explain the results you have seen thus far.Readers who are interested in learning more about skin disorders can order my Health Report "Dermatitis, Eczema and Psoriasis" by sending a self-addressed, stamped No. 10 envelope and a $2 U.S. check or money order for each report to Dr. Peter Gott, P.O. Box 433, Lakeville, CT 06039. Be sure to mention the title, or print an order form from my website's direct link: www.AskDrGottMD.com/order—form.pdf.-------------

Dr. Peter H. Gott is a retired physician and the author of several books, including "Live Longer, Live Better," "Dr. Gott's No Flour, No Sugar Diet" and "Dr. Gott's No Flour, No Sugar Cookbook," which are available at most bookstores or online. His website is www.AskDrGottMD.com.