The author presents a review of the current evidence on the use of topical photodynamic therapy (PDT) for treating papulopustular rosacea, initially with a brief overview of the aetiology of the disease and licensed treatment options, before exploring the context of the emerging off-label interest of topical photodynamic therapy for this condition. The mode of action of conventional treatment is discussed with a summary of the literature findings comparing aminolevulinic acid (ALA) and methyl-aminolevulinic acid (MAL) as the most commonly used photosensitiser drugs. The limited collection of off-label studies hypothesise that the mode of action in the context of treating rosacea is thought to be a destructive effect on the sebaceous glands and an immunomodulatory effect with red light demonstrating the most potent effect, compared to blue and pulsed light. The literature is consistent in pre-treatment considerations, but highly variable in the context of incubation times for off-label applications such as rosacea as standardised times have been based on licensed indications for non-melanoma skin cancers. The author recommends that oral ibuprofen may be taken before illumination, yet, there is currently no consensus to support this. Similar side-effects and aspects of post-treatment care are described in the context of PDT for rosacea, akin to conventional protocols, with emphasis placed on the need for further research for standardised treatment protocols.