Acne vulgaris is one of the most common disorders encountered by dermatologists in the clinical setting. Although it is well recognized that the back and chest may be affected in many patients, little data exist regarding the prevalence, grading, and treatment of truncal acne vulgaris. Results of clinical studies suggest that as with facial acne vulgaris, combination therapy is optimal. This article discusses clinical challenges related to the management of truncal acne vulgaris, a system for rating disease severity, and recommendations regarding the use of topical and systemic therapies.