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While the etiology of rosacea is multifactorial, it is not surprising that treatment has been controversial. Pulsed dye laser (PDL) has been successfully used to treat vascular components of rosacea. Ivermectin 1% cream is an emerging treatment of rosacea. To provide a comprehensive clinical and dermatoscopic comparative study between the efficacy and safety of pulsed dye laser alone versus its combination with topical ivermectin 1% in the treatment of rosacea. Thirty Patients were randomly divided into two groups. Group A ( n  = 15) treated with 585 nm PDL, and group B ( n  = 15) treated with 585 nm PDL and topical ivermectin 1% cream. All patients received four laser treatments with a 4-week interval. The efficacy of treatment was assessed by photographs and dermoscopic photomicrographs at baseline and 3 months after the final treatment. The patient’s level of satisfaction was also recorded. At the 3-month follow-up, group B induced better clinical improvement than group A. However, this difference was not significant. No serious adverse events were observed in either treatment group. This study supports the efficacy of PDL treatment for patients with rosacea. PDL could be more effective when combined with ivermectin 1% cream.