Hidradenitis suppurativa (HS) is a common skin disease affecting an estimated 2% of the population. It causes significant symptoms and is notoriously difficult to treat. In this article, the current medical therapy is reviewed. At the present time, therapy appears to be based on an interpretation of the disease as either infectious or a form of acne. The understanding of the pathogenesis of HS suggests that these are not adequate models in order to understand the disease and this may explain the insufficiency of currently available medical treatment. The literature is sparse and there is a shortage of randomised, controlled trials. Three small, randomised, controlled trials have suggested that clindamycin, tetracycline and oestrogens and cyproteroneacetate may have an effect in some patients. Preceiving HS as an inflammatory skin disease suggests the use of general immunosuppressive drugs in the treatment of this condition. This approach, using both traditional immunosupressants and monoclonal antibodies, has been assessed in a small number of patients and appears to have some potential. However, the main source of evidence for this are case series and there is a strong need for more formal studies in this potentially debilitating disease.