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The goal of this book is to assist the curious, motivated person in becoming a more perceptive observer of fingernails to improve one’s skills in diagnostic examination. The fingernail assessment is an essential part of the physical examination. This approach is especially satisfying when it promptly leads to an accurate diagnosis and to the patient’s relief of suffering and distress. It is difficult to overstate the potential utility of this information that is hidden in plain view. This manual is not meant to be an exhaustive compendium. Diagnostic utility and useful observations have been favored over interesting, but useless minutia. The approach is unapologetically personal and shows one person’s way to systematically examine and interpret fingernail findings. It is what I use in my daily clinical practice and is not meant to be a comprehensive evidence based review of digital dermatology. My secondary intention is to make the material available to a general audience. Healthcare is changing and the more we know about our own health the more effective we can be in making wise decisions when we interact with healthcare professionals. Fundamental observations refined and prospectively validated through over thirty-five years of active, hands on, clinical practice forms the basis of the work.