Fractional CO2 Laser 2-Mercaptonicotinoyl Glycine Drug Delivery for Melasma and Facial Hyperpigmentation: A Real-Observational World Experience

Background: Melasma and facial hyperpigmentation are common dermatologic conditions that significantly impact patients’ quality of life. New approaches such as laser-assisted delivery of topical agents have been proposed to enhance treatment outcomes. Objective: To evaluate the comparative effectiveness of fractional CO2 laser-assisted delivery of 2-mercaptonicotinoyl glycine (2-MNG) versus topical 2-MNG alone in a real-world clinical setting. Methods: Fourteen female patients with mild-to-moderate melasma or hyperpigmentation were enrolled, and eleven completed the 16-week study. Participants were allocated to either the laser +2-MNG group (n = 6) or topical 2-MNG only group (n = 5). Assessments were performed at baseline and every four weeks using VISIA CR® imaging (visible, UV, and brown spots), Modified Melasma Area and Severity Index (mMASI), and Dermatology Life Quality Index (DLQI). Results: Both groups showed significant improvement in visible spots, brown spots, mMASI, and DLQI scores. The laser group showed earlier improvement, with significant changes starting at week 8, while the control group reached significance at week 12. No significant change in UV spot scores was observed. Conclusion: Both approaches were effective in reducing clinically visible pigmentation and improving quality of life. Fractional CO2 laser-assisted delivery offered a faster onset of efficacy.