Hidradenitis suppurativa is a chronic, recurrent inflammatory disease affecting the cutaneous apocrine glands and resulting in their obstruction [1]. This enigmatic disease causes recurrent episodes of infection, edema, scarring, and fibrosis of surrounding tissues. We present the unusual case of a 58-year-old white male with fifteen years of hidradenitis suppurativa (HS) complicated by the occurrence of penoscrotal elephantiasis.