Rosacea is likely going undiagnosed in patients with skin of color. That is the core finding highlighted by The American Journal of Managed Care, and it lands on a familiar fault line in dermatology: erythema, telangiectasia and papulopustular changes present differently across Fitzpatrick phototypes, and clinicians keep missing them.

We don't have a study name or effect size in the source itself. What we have is the editorial verdict — "likely underdiagnosed" — from a managed care publication, which tells you the conversation has already moved past the exam room. Payers and policy editors are now tracking the gap.

Why does this matter for practitioners? Because an underdiagnosis signal in a managed care outlet usually precedes the awkward questions: prior authorization friction, delayed treatment, and claims data audits that flag disparities in who gets diagnosed and when.

Why the diagnosis gets missed

The clinical logic is well established even where the source is terse. Rosacea's hallmark signs — persistent erythema, flushing, visible vessels — are harder to visualize on darker phototypes. Redness reads differently. Background pigmentation masks the vascular component that anchors diagnosis in lighter skin.

So patients get other labels instead. Steroid-responsive dermatoses, contact dermatitis, acne, even seborrheic dermatitis. Each mislabel carries a treatment path. Some of those paths make rosacea worse — topical corticosteroids in particular are a known aggravator.

The result: delayed care, longer disease duration before correct treatment, and a patient cohort that management literature has flagged as systematically underserved.

What does this change for your practice?

Practically, three things.

• Look past erythema. On skin of color, anchor the exam on symptoms the patient reports — burning, stinging, flushing triggers — plus papules and pustules, rather than waiting for obvious redness.
• Question the working diagnosis. A "treatment-resistant acne" in a patient with flushing symptoms deserves a rosacea re-look before the next escalation step.
• Document the reasoning. If managed care is tracking the gap, chart notes that show symptom-based diagnostic logic will hold up better than notes keyed to visible erythema alone.

The source doesn't quantify the gap, so don't quote a percentage at your next staff meeting. Treat this as a direction-of-signal story, not an effect-size story. The signal, though, comes from a credible managed care platform, which gives it weight beyond a single clinic's anecdote.

The road ahead

Expect this to feed into the broader disparity metrics now shaping dermatology quality reporting. Whether it shows up first in payer policy, screening guidance or CME content, the practical move today is the same: widen your diagnostic lens before the gap gets measured in your own claims data.