Tumor necrosis factor (TNF) inhibitors have emerged as an important treatment option for patients with moderate to severe hidradenitis suppurativa (HS). This chapter explores the role of TNF inhibitors in the treatment algorithm for HS, focusing on their immunomodulatory effects, efficacy, and safety profiles. Key clinical trials are discussed for each agent, in addition to their recommended dosing strategies. The chapter also addresses the potential risks and challenges of TNF therapy, including development of anti-drug antibodies and risk of opportunistic infections, and highlights the need for adjusting treatment plans based on patient response and comorbidities.