Accurate assessment of disease severity and treatment response are essential in the clinical management of hidradenitis suppurativa (HS) and vital in research efforts, particularly investigations of potential therapeutics. Key elements of the history and physical examination can inform treatment decisions to meet the needs of each individual patient. Over time, and through diligent and purposeful research, outcome measures capable of accurately and reliably assessing treatment response suitable for both research and clinical use have been developed and refined. This review explores HS clinical assessment, existing outcome measures, and emerging tools to enable accurate assessment, improve care, and optimize treatment strategies.