Carnosine is a dipeptide composed of β‑alanine and L‑histidine, linked by peptide bonds, and is widely distributed in muscle tissue, the central nervous system (including the brain) and various other organs. As an endogenous bioactive molecule, carnosine plays a crucial role in cellular metabolism and physiological regulation. In recent years, advancements in molecular biology, biochemistry and pharmacology have gradually unveiled the multiple biological functions of carnosine, leading to increased interest in its potential applications for disease therapy. Carnosine exhibits considerable antioxidant and anti‑glycation properties, while also demonstrating unique pharmacological effects related to neuroprotection, anti‑inflammatory responses and immune regulation. These attributes position carnosine as a significant intervention with therapeutic value across various pathophysiological processes associated with different diseases. This review systematically summarizes recent progress on the application of carnosine in disease therapy, focusing on its mechanisms of action and therapeutic roles in neurodegenerative diseases, metabolic disorders, cardiovascular diseases, several types of cancer and ophthalmic conditions. By reviewing existing studies on this topic, this review aims to further explore the diversity of carnosine's roles along with potential mechanisms involved in disease treatment. Ultimately, it aims to provide a theoretical foundation and direction for future research.