Truncal acne – acne vulgaris involving the chest, back, or shoulders – is thought to be present in more than half of patients with acne. Because the study of acne has been focused on the face, there are sparse data in the literature about the clinical characteristics and management options for truncal acne. It is thought that the pathogenic process is similar between the face and the back, suggesting that treatments studied on the face may be suitable for use on the back. It is not uncommon for patients to omit discussion of truncal acne with their treating physician, and it is likely that non-facial acne is under-diagnosed and under-treated. Scarring and pigmentary problems are common sequelae of acne on the trunk, underscoring the need for early and effective treatment as a preventive measure. Truncal acne merits consideration and should be more thoroughly studied. Initiating treatment with a topical retinoid combined with an antimicrobial agent is logical for most patients with truncal acne, and mirrors recommendations for facial acne; however, there are additional considerations for truncal acne such as extension of the lesions, risk of antibiotic resistance due to large surface areas treated for a prolonged duration, accessibility of lesions, and discoloration of clothing or bedding due to topical products. Oral isotretinoin is the treatment of choice when truncal acne is severe. This article reviews available information as well as recent recommendations for treatment. J Drugs Dermatol. 2019;18(12):1205-1208.