Hidradenitis suppurativa in pediatric patients presents unique challenges in diagnosis and management. This chapter explores the clinical presentation, diagnostic challenges, current management strategies, and psychosocial impact of HS in children and adolescents. The mean age of onset is around 12.5 years, with a higher prevalence among females. Diagnosis is challenging due to atypical presentations and overlap with other conditions, often leading to delays in treatment. Management strategies are adapted from adult guidelines, and include topical treatments, systemic antibiotics, hormonal therapies, and biologics, with adalimumab approved for patients 12 years and older. Obesity and metabolic syndrome are common comorbidities linked to HS through shared inflammatory pathways. The psychosocial impact of HS on pediatric patients is significant, affecting self-esteem, social interactions, and quality of life. Early recognition and a multidisciplinary approach are crucial for improving outcomes in pediatric HS.