Hidradenitis suppurativa is a chronic, systemic, inflammatory skin disease characterized by inflammatory nodules, painful abscesses, and draining tunnels. It is associated with significant comorbidities, including inflammatory bowel disease, arthritis, pain, and a reduced quality of life. Unlike psoriasis or atopic dermatitis, it can progress from an inflammatory state to a nonreversible scarring component if not treated early enough and in an evidence-based manner. Until recently, adalimumab has been the only approved treatment for hidradenitis suppurativa. Many conventional systemic treatments are currently used and have an appropriate role in hidradenitis suppurativa therapy, provided they are used correctly in suitable patients. Unfortunately, many therapies, including antimicrobials, are used empirically, leading to continuous cycles of incorrect and inefficient treatment, disease progression, and reduced quality of life. Contributing to the problem is the delay in diagnosis, which may be as long as seven years, and insufficient or inappropriate intervention. Capturing the "window of opportunity" is essential for a disease such as hidradenitis suppurativa.