Purpose of Review <p>This narrative review explores the current understanding of itch in hidradenitis suppurativa (HS), a common yet underrecognized symptom that contributes significantly to patient burden. Herein, we summarize HS-associated itch pathophysiology, clinical impact, and management.</p> Recent Findings <p>Emerging evidence indicates that itch affects more than half of patients with HS and arises from a complex interplay of immune dysregulation, mast cell activation, neural sensitization, and local irritation. Specific inflammatory markers such as IL-17, IL-31, and CCL-26 potentially play a role in itch pathogenesis. The degree of HS-associated pruritus correlates with disease severity, pain, drainage, and impaired quality of life. Recent studies suggest that topical clindamycin, strontium cream, bimekizumab, brodalumab, apremilast, povorcitinib, remibrutinib, and fostamatinib may improve HS-associated pruritus.</p> Summary <p>Itch significantly contributes to HS disease burden yet often remains underassessed in clinical care. Standardized measurement tools and targeted therapies are needed to improve patient outcomes and guide future research.</p>