Digital ulcerations or infarctions rarely occur in primary RP alone and almost always reflect a secondary cause, which may include associated connective tissue diseases or exposure to precipitating medications, such as vasoactive modulators.20 This understanding reaffirms concerns about the use of CGRP agents in primary RP, where complicating digital infarctions or ulcerations would ordinarily be highly atypical. The gene discussed is CALCA; the disease is retinitis pigmentosa 1.