I've been on accutane 3 times in my life.
My family has a history of severe nodular acne. My grandfather, mother, and my siblings all suffered from it.
My brother had it the worst, but I still had it quite bad. I have facial scars from it.
It can be quite traumatic, psychologically. My parents and doctor were reluctant to offer me accutane - so I spent a couple years really suffering, trying all kinds of treatment that had little effect (I believe it was benzyl peroxide -> antibiotics -> some other stuff). I turned into a social recluse, I hated looking at myself in the mirror.
Accutane was the only thing that worked. It was truly a miracle drug for me. I ended up doing two courses as a teenager which knocked it into remission, through my university years.
It came back in my mid 20s moderately, so I tried the benzyl peroxide (the acne.org regimen). But it was a pain to apply regularly, costly, and it stained all my clothes. I could only wear white shirts. After a year of that, I went and did another treatment of accutane and it knocked it out.
I still suffer from mild acne to this day - in my late 30s. I keep it under control with salicylic acid pads, so it's very manageable. I also avoid touching my face/neck, which seems to exacerbate it.
Accutane can have a few reported permanent side effects. One is IBS. I was diagnosed w/ IBS after taking my last course of accutane. It's hard to know if it is the cause or not (my mother also suffers from IBS, so it may be genetic). It sucks, but the acne was far worse and I'll never regret taking accutane. The IBS is relatively mild - only gets bad when I'm stressed.
Treatment used to be much more draconian. In the 40s-70s, doctors would x-ray your face to eliminate severe acne. My high school physics teacher had this done, and unfortunately passed away in his early 50s due to throat cancer (having never smoked in his life).