Acrodermatitis continua of Hallopeau (ACH) is a rare, sterile, pustular eruption in the tips of the fingers or toes. ACH is notorious for its refractoriness to treatment and so limited success is reported with various treatment modalities. The patient was a 60-year-old man who presented with 3-year history of painful pustular eruptions on the nail beds of all fingers along with severe nail dystrophy. Clinical and microbiological examination did not show any evidence of bacterial or fungal infection. Histopathological examination of the pustular plaque showed a subcorneal cavity filled with neutrophils and lymphohistiocytic infiltrates in the upper dermis. A diagnosis of ACH was confirmed, and the patient was initially treated with a topical corticosteroid and calcipotriol. However, his symptom was not improved and the following systemic treatments including monotherapy of methotrexate, acitretin, and cyclosporine, and combination of acitretin with methylprednisolone, and cyclosporine with acitretin were administered, which led to only limited responses. Owing to poor control of acral pustulation and nail destruction, oral alitretinoin was administrated. After 8 weeks of alitretinoin30 mg/day treatment, the skin and nail lesions of the patient dramatically alleviated without any side effects. We suggest that oral alitretinoin can be a reasonable and reliable therapeutic option for recalcitrant ACH like this case.