Rosacea is one of the most common diseases faced by dermatologist in clinical practice. Pathogenesis is based on pathology of the immune and neurovascular systems. Patients often note a pronounced reduction of life quality reflected in restriction of social and personal life due to facial localization, long-term uncontrolled course, exacerbations in presence of triggers and limited treatment methods. A number of topical drugs, including azelaic acid, are used for rosacea treatment. The article systematizes and analyzes the world literature data on the use of azelaic acid in the frame of comprehensive rosacea therapy. Own clinical observations of the use of azelaic acid in the therapy of patients with rosacea are given. Topical drugs containing azelaic acid are effectively used for long duration in the treatment of acne and rosacea, both as monotherapy and in the comprehensive treatment of disease in more severe forms. Azelaic acid is included in foreign and Russian clinical guidelines on the treatment of rosacea and acne. The anti-inflammatory effect of azelaic acid in rosacea is related to reduction of neutrophil metabolism and decreased production of oxygen free radicals. It is also important to note the depigmentation effect of azelaic acid, associated with the suppression of abnormal melanocytes. Convenient form of a gel, cream, quick and easy application positively affect the patients’ compliance and choice as a first-line basic therapy or alternative rosacea therapy.