Specifically, the authors expressed concern that chilblain lupus could be confused with lupus pernio. Although this is an obvious problem in terms of nomenclature, we feel that in clinical practice these entities are distinct and are unlikely to be confused for many of the reasons cited by Arias-Santiago and coauthors. Chilblain lupus is usually associated with systemic lupus erythematosus. It is extremely rare, with only 70 cases reported in a 2008 review.2 It involves primarily the toes and fingers; involvement of the ears or nose is rare.2 The lesions generally occur first during cold or damp periods. They are usually pruritic and later painful; such symptoms are extremely unusual with lupus pernio. Pathologically, chilblain lupus reveals vascular thrombosis and not granulomatous inflammation.2,3 Furthermore, although both systemic lupus erythematosus and sarcoidosis are systemic diseases, we disagree with Arias-Santiago and coauthors that they are difficult to distinguish clinically.