Alitretinoin, also known as 9-cis retinoic acid, was initially approved by the United States Food and Drug Administration in 1999 for treatment of localized Kaposi sarcoma in the form of 0.1% topical gel, which represents the isomerization of tretinoin. Several pharmacodynamic processes take place, and the expressed proteins cause the clinical and therapeutic effects of alitretinoin. The apoptotic and antiproliferative effect of alitretinoin has been used in the treatment of localized Kaposi sarcoma. Suppression of chemokine receptor expression and inhibition of chemotaxis represent the main mechanism of alitretinoin's anti-inflammatory and immunomodulatory effects. The topical gel formulation of alitretinoin may also be used in pyogenic granulomas in the context of similar histologic features with Kaposi sarcoma. Palmoplantar pustular psoriasis is another disease in which alitretinoin has been successfully used. Alitretinoin is a unique synthetic retinoid capable of binding to all known retinoid receptors.