Cactiform succulents, belonging to the Euphorbia genus, are distinctive species found in the arid and semi-arid ecosystems of Macaronesia and the Arabian Peninsula. Resembling cacti in appearance, they exhibit unique morphological characteristics, such as succulent, green-stemmed structures with ribs, accompanied by a pair of stipular spines. These plants have evolved to thrive in well-draining substrates, including both surface and rocky soils, potentially as an adaptive strategy to combat edaphic drought conditions. Although initially associated solely with arid and desert environments, it is important to note that these cactiform succulents are not exclusively specialized for prolonged dry periods. Rather, they demonstrate morphological adaptations that help them endure arid conditions. The primary objective of this review is to provide an up-to-date synthesis of knowledge concerning cactiform succulents within the Euphorbia genus. It aims to underscore their capacity to flourish in both arid and semi-arid zones, while underscoring the pressing conservation challenges that threaten these plants with degradation and potential extinction. The prevailing climatic conditions, marked by extended and recurrent droughts exacerbated by escalating temperatures, climate fluctuations, and escalating human impact, collectively pose a formidable obstacle to conserving these cactiform succulents and their respective ecosystems. All these threats jeopardize these invaluable natural resources, which hold multifaceted significance spanning environmental, socio-economic, and medicinal domains.