Background: Anecdotal observations suggest that retinoic acid may be effective in mild rosacea. Aim: Our aim was to investigate, by an exploratory clinical and instrumental study, the effects of a topical formulation with the retinoic acid precursor retinaldehyde, in patients with vascular signs of facial rosacea. Methods: Female patients were treated with a 0.05% retinaldehyde cream that was applied once daily for 6 months. Clinical assessments of persistent erythema and telangiectasia were performed every month, using a 4-point severity score (absent to severe). The clinical response for each parameter was defined as a decrease of at least 1 grade in the severity score. In addition, erythema was further evaluated by measurement of the a* parameter, using a spectrophotometer on lesional and nonlesional areas. Results: A total of 23 women comprised the study population. At baseline, 10 patients had diffuse erythema, 3 patients had isolated telangiectasia and 10 patients had both. During retinaldehyde treatment, a clinical response was revealed in about 75% of the patients with erythema, after 5 months (p < 0.05). Similarly, isolated telangiectasia responded to retinaldehyde, although to a lesser extent and after a longer period of treatment (46% responders after 6 months, nonsignificant). Using the spectrophotometer, the a* parameter diminished in patients with erythema by about 15%, after 2 months of treatment (p = 0.001). Conclusion: This study indicates that retinaldehyde has beneficial effects on the vascular component of rosacea.