“Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a significant quality-of-life impact. In addition to the 2 drugs approved by the Food and Drug Administration for HS, adalimumab and secukinumab, several other biologic and small molecule inhibitors are used off-label or are in clinical trials. A systematic and evidence-based approach using these and other therapies—considering patient comorbidities, response to therapy, dose adjustment, and frequent troubleshooting—is required. In this article, we review the latest evidence supporting anti-inflammatory biologic and small molecule therapies for HS and provide a practical, algorithmic approach to management incorporating experience and expert opinion.”