Introduction: hidradenitis suppurativa (HS) is a rare disease with increased prevalence. Clinical manifestations often start at puberty. Early lesions can mimic other dermatological disorders which delays diagnosis and increases the risk of progression, leading to extensive lesions over the body, limited daily activities and a negative psychological impact. There are some risk factors although they are not very specific. The diagnosis is based on identifying the lesions and their typical distribution. Some severity and prognosis scales for HS may be useful. Case presentation: this is a case of long-standing hidradenitis suppurativa associated with a genetic component, which has received numerous treatments, but none has been effective in controlling the condition. Currently the disease stage is advanced with systemIc involvement and decreased quality of life. She is being treated with tumor necrosis factor- alpha inhibitors monoclonal antibodies. Conclusions: it is paramount to be aware of this pathology, to suspect it and exclude a differential diagnosis, to provide timely therapy and thus prevent progression and complications associated with lasting reduction in quality of life.