Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that may cause debilitating pain and itch. Given their physical and psychological burden, recognition and treatment of HS-associated symptoms are critical for supporting patients with HS. The complex nature of HS pain, encompassing acute and chronic timing as well as nociceptive, neuropathic, and nociplastic character, requires a tailored treatment approach. Itch in HS, although less studied, is also a prevalent and distressing symptom. The aim of this narrative review is to apply current knowledge of HS pain and pruritus to develop a practical approach for symptomatic management in the dermatology office.