I did accutane (isotretinoin) too...best decision I ever made
I was 26 years old with at least 13 years of messing around with various topical anti-acne agents like clindamycin with and without benzoyl peroxide, retinoids like Veltin and Retin-A micro, and oral antibiotics. I finally had enough and went to my dermatologist and told her I was ready to do more and wanted to try accutane. I did a lot of research before hand and talked with my brother who went through it a few years before me who recommended I give it a try.
My dermatologist went over all the details of risks and side effects, rules dictated by the iPledge program, and the results I could expect. The drug is Category X for pregnancy, meaning, don't even think about it because you likely will have severe birth defects or miscarry (lucky for men, this doesn't apply to them even if they get a woman pregnant while he's taking accutane). There are a whole bunch of other reasons you can't be on accutane, which I don't know, but you can ask your doctor if it's possible and if you're considering it. Side effects are most commonly dry lips and dry skin - I definitely had dry lips which my doctor told me I would have, but it wasn't something I couldn't deal with or couldn't keep under control with constant Aquaphor or Carmex lip balm. My brother who did it had some dry eye issues and had a couple nose bleeds, but they weren't bad enough he couldn't just use eye drops and saline nasal spray to control. In my last couple of months my doctor increased my dose (I did 6 months of treatment) and my cholesterol went up from normal range to slightly above 200 (something like as high as 214, if I remember correctly), and I also had some pretty bad joint pain. I did the required blood work 30 days before starting, then monthly while I was on it, then did the 30 day-post blood work. To no surprise of my doctor, my elevated cholesterol, joint pain, and dry lips went away after the 30 days - which she couldn't guarantee to me, but did happen as she suggested it would.
I was able to live through it all seeing the dramatic change in my skin from constant and cyclical breakouts, to none at all and just dealing with the residual scarring and dark marks. This lack of acne continued after my course and, now, almost 10 years later, rare, and I mean really really rarely, I have a single pimple pop up (usual because I had a ton of makeup on my face for way too long). Not everyone is this lucky, so I've been told, but I am so thankful my doctor walked me through the process and made it all possible.
One thing to note is that when you're doing your research like I did, some scary stuff popped up on blogs and forums, but remember, you can't believe everything you read, nor can you believe that something that bad will happen to you. My advice is, if you're considering it and have questions or concerns, just talk to your doctor to see if they are #1 true, #2 likely, #3 preventable or can be monitored. My biggest regret (or gripe with my prior dermatologists) was not doing it sooner. So if you're at your wits end, starting to see scarring, and/or ready to commit to several months of accutane with monthly blood work, call your dermatologist for an appointment ASAP!