To the Editor: Pernio, also referred to as chilblains, is a rare inflammatory condition presenting as painful swelling and erythema of acral sites upon cold exposure.

While pathophysiology is uncertain, vasospasm is likely at play, akin to Raynaud syndrome. 1 Many cases of pernio are often thought to be idiopathic, but its presence often prompts further investigation. Currently, there is a paucity of literature exploring the association between pernio and connective tissue diseases (CTD) besides in cutaneous lupus.2

Therefore, we performed a population-level retrospective cohort study to evaluate the association between pernio and autoimmune CTD in the absence of Raynaud’s