Hidradenitis suppurativa is a complex disease of chronic evolution and difficult management. Imaging, particularly color Doppler ultrasound, has demonstrated a wide range of subclinical anatomic abnormalities, allowing modification of the clinical assessment of severity of the disease and therefore management of patients. Sonography supports early and more precise diagnosis and staging by providing critical objective information in real time. The richness of these data can also support assessment of the pathogenesis of the disease, allow monitoring of patients, and contribute to clinical trials. MRI can support the diagnosis of extensive anogenital and deep lesions.