Several studies report the usefulness of different biological therapies in the management of a difficult-to-treat pathology such as hidradenitis suppurativa (HS). However, there are little data on this, which shows the great difficulty in the management of this disease. We will report herein our experience of the treatment of four complex cases of HS. We will also review previous cases published in the literature in order to further assess the results obtained with different biological drugs in terms of efficacy and safety. We conclude that, in the near future, biological therapy could become an essential tool in the management of cases of HS who have not previously responded to classical treatment.