Background and Objectives: Erythromelalgia (EM) is an uncommon condition marked by recurring redness, intense burning sensations, and elevated limb warmth. This syndrome can be significantly debilitating, and finding effective treatment options often proves to be quite difficult. The symptoms can severely impact the quality of life of those affected, resulting in considerable disability. This systematic review aims to compare available medical treatments for EM by evaluating their efficacy and safety. Materials and Methods: Following PRISMA guidelines, the search included the PubMed, Medline, and Web of Science databases, using the keywords (“Erythromelalgia” OR “Mitchell’s Disease”) AND (“Erythromelalgia Treatment” OR “Erythromelalgia Management”). Results: From the 103 papers extracted through the database search, six articles were considered suitable for the systematic review. The included studies investigated various interventions used for a total of 120 patients, including iloprost (n = 8), misoprostol (n = 21), topical amitriptyline-ketamine (n = 36), lidocaine (n = 27), chemical lumbar sympathectomy (CLS, n = 13), and various pharmacological agents (n = 11). The outcomes showed significant improvements in areas like pain reduction, cooling scores, and temperature regulation. Iloprost and misoprostol exhibited notable benefits in cooling scores, sympathetic dysfunction, and EM severity compared to placebos. About 75% of the patients reported pain relief with topical amitriptyline-ketamine, while lidocaine reduced nociceptive feelings in a dose-dependent manner. Conclusions: Comparing interventions demonstrated consistent clinical benefit with varied tolerability. However, adverse events ranged from mild gastrointestinal symptoms to severe complications such as disability and depression, requiring careful monitoring. Given EM’s diverse symptoms and comorbidities, treatment efficacy varies among individuals. A personalized approach incorporating genetic testing, multidisciplinary care, and long-term monitoring is essential to optimize outcomes. Continued research is vital to advance understanding of EM’s pathophysiology and improve patient care.

Background: Optic neuritis (ON), a common manifestation of demyelinating disorders such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), often leads to significant visual impairment. Although high-dose corticosteroids are a first-line therapy, many patients experience incomplete recovery. Apheresis therapies, including plasma exchange (PLEX) and immunoadsorption (IA), are being increasingly used as rescue treatments, but their efficacy and safety are debated. Methods: We conducted a systematic review and meta-analysis of studies evaluating PLEX and IA for acute ON in patients with demyelinating diseases. Four databases were searched up to January 2025. The included studies reported visual or neurological outcomes in patients with MS, NMOSD, MOGAD, or idiopathic ON. The primary outcomes were treatment response and visual acuity changes (logMAR). The study quality was assessed using RoB 2, ROBINS-I, or JBI tools. Random effects models were employed for the meta-analysis. Results: Twelve studies (800+ ON attacks) were analyzed. Both PLEX and IA demonstrated significant visual improvement, with a pooled mean logMAR reduction of -1.11 (95% CI: -1.70 to -0.53). Early intervention correlated with better outcomes. MOGAD-ON patients showed the highest response rates, while delayed treatment in NMOSD-ON patients was linked to poorer vision. Adverse events were rare and mild. Conclusion: PLEX and IA are effective and safe second-line therapies for steroid-refractory ON, particularly when initiated early. These findings support the prompt use of apheresis in eligible patients to optimize visual recovery.