Bixa orellana L., commonly known as annatto, achiote or lipstick tree. It is a tropical plant widely recognized for its medicinal, cultural and economic importance. It is native to tropical America, but has been extensively cultivated across Asia, Africa, and other tropical regions. Indigenous communities have traditionally used annatto for medicinal purposes, body painting, food coloring and ritual practices. The plant contains numerous bioactive compounds such as carotenoids, flavonoids, terpenoids and alkaloids that contribute to its pharmacological activities. Ethnomedicinally, it is used for treating inflammation, gastrointestinal disorders, infections, diabetes and skin diseases. In addition to its medicinal value, annatto has profound cultural significance among indigenous populations, particularly in Latin America, where it has historically been used for body paint, cosmetics and ceremonial rituals. The seeds produce annatto dye, an important natural colorant widely used in food, pharmaceutical and cosmetic industries. This review explores the ethnomedicinal uses and economic importance of B. orellana. Understanding these traditional applications can contribute to future pharmacological research and the conservation of ethnobotanical knowledge.