<p>Hidradenitis suppurativa is a chronic recurrent inflammatory disease in which conventional clinical examination frequently underestimates subclinical extension and fails to distinguish between lesion types that carry different therapeutic implications. High-frequency ultrasound has emerged as a valuable adjunct, enabling detection of deep and occult disease, more granular assessment of inflammatory activity, and refined classification beyond traditional Hurley staging and the International Hidradenitis Suppurativa Severity Score System (IHS4). Over the last decade, multicenter studies and expert consensus have progressively defined high-frequency ultrasound lesion phenotypes, sonographic scoring systems, and workflow recommendations, positioning ultrasound as a practical bedside imaging tool for hidradenitis suppurativa. This Leading Article provides a concise balanced overview of high-frequency ultrasound in hidradenitis suppurativa, with an emphasis on unified lesion terminology, Doppler-based activity assessment, and an iconographic color-coded mapping strategy that links each ultrasound-defined lesion to its exact clinical location. The article highlights how such approaches can bridge communication between dermatologists, sonographers, and surgeons, support lesion-level decision making, and guide surgical planning, while also discussing current limitations, implementation barriers, and priorities for future research.</p>