Purpose of Review <p>Currently, there are no standardized, evidence-based guidelines to support clinical decision-making for the inpatient management of hidradenitis suppurativa (HS). This review aims to address this gap by proposing a structured framework to guide the care of hospitalized patients with HS.</p> Recent Findings <p>Although HS pathophysiology is not fully understood, research increasingly supports the hypothesis that HS is an autoinflammatory disorder, rather than primarily a process of follicular occlusion. This evolving understanding has informed the use of targeted immunotherapies and surgical inflammatory debulking.</p> Summary <p>While outpatient treatment options have advanced, data guiding inpatient management remains scarce. This review proposes an evidence-based approach to guide the inpatient dermatologist in optimizing care for hospitalized patients with HS.</p>