Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin disorder characterized by recurrent painful nodules, abscesses, and sinus tracts in intertriginous regions. Affecting approximately 1% of the global population, HS disproportionately impacts women and African American individuals in the United States. Pathogenesis involves follicular occlusion, immune dysregulation, bacterial dysbiosis, and genetic susceptibility. Clinically, HS presents along a morphological spectrum, often requiring staging tools like Hurley classification or the more nuanced IHS4 for disease assessment. Histopathology reveals follicular hyperkeratosis, rupture, and chronic inflammation. Treatment ranges from lifestyle modification and antibiotics to biologics, such as adalimumab, secukinumab, and bimekizumab, and, in severe cases, surgical intervention. Accurate diagnosis requires distinguishing HS from mimickers like furunculosis, cutaneous Crohn’s disease, and folliculitis. Effective management hinges on disease severity, multidisciplinary care, and early recognition to minimize progression and improve quality of life. This chapter provides a comprehensive review of HS, with emphasis on updated staging systems, histopathology, and treatment strategies.