Although the pathophysiology of rosacea has not been completely elucidated, this chronic, relapsing dermatosis appears to be caused in part by the release of proinflammatory mediators from neutrophils. The effectiveness of some interventions, including topical azelaic acid and metronidazole, may be related to their anti-inflammatory activity. A 15% gel formulation of azelaic acid (Finacea® 15% Gel), with improved pharmacological properties compared with an older azelaic acid 20% cream, has been shown to reduce erythema and inflammatory lesions in rosacea. Topical azelaic acid 15% gel was found to be more effective but transiently more irritating than topical metronidazole 0.75% gel in moderate papulopustular rosacea. Newer agents such as azelaic acid 15% gel provide physicians and patients with an expanded range of treatment options.