The experts recommended that“intravenous prostanoids are considered when oral therapies (including calcium channel blockers and PDE-5 inhibitors) have failed” and they also recognize that“fluoxetine is a useful alternative for treatment of SSc-RP, in particular in patients with SSc who cannot tolerate or do not respond to vasodilators” (Kowal-Bielecka et al., 2017). This evidence concerns the gene PDE5A and retinitis pigmentosa 1.