Minocycline is an antibiotic used for several dermatologic conditions, including rosacea. The development of skin, scleral, and nail hyperpigmentation may occur with long-term use of minocycline, and this is associated with no adverse effect on function. We present a case of a 66-year-old male who developed blue-gray hyperpigmentation of his nail beds after treating rosacea with systemic minocycline for over 20 years. The remainder of the physical exam was unremarkable for hyperpigmentation elsewhere. The patient was informed that this was likely an adverse effect of his chronic minocycline use. He insisted upon the continuation of minocycline, so he was counseled on the adverse effects of the medication and scheduled for follow-up.