Hidradenitis suppurativa is a chronic relapsing disorder of follicular occlusion that is often recalcitrant to therapy. Topical and systemic antibiotics, hormonal therapies, oral retinoids, immunosuppressant agents, and surgical treatment are some of the therapeutic alternatives used for this often recalcitrant and frequently troublesome disorder. This article reviews the pathophysiology of hidradenitis suppurativa, an evidence-based analysis of standard treatments, and recent advances in the therapy of this disorder.