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Patients with moderate to severe HS often seek care in the emergency department and may require hospitalization; however, the lack of clear admission criteria and management guidelines presents significant challenges. To address these issues, we conducted a clinical review aimed at hospitalists and consulting dermatologists considering hospital admission for patients experiencing severe HS flares. Admission offers a unique opportunity to optimize care through specialized consultations, pain management, rescue therapy, and surgical planning. Furthermore, multimodal treatments, particularly biologics, are needed to achieve clinical remission in severe disease. Streamlining care during hospitalization for the early initiation of these therapies can significantly improve flare management and overall clinical outcomes for HS patients. 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