One of my friends took Accutane as soon as he got his first pimple, because his lawyer father wanted his son on the strongest treatment available. It certainly seemed to work for my friend.
My parents are both doctors, so they felt it was best to start with less powerful acne treatments and see if those would work. (Doctors are the only parents that triage their children out of treatment.) Somehow, it took them 4 years after my friend started taking Accutane to figure out that the less powerful treatments weren't working.
At 13, I started taking doxycycline, an antibiotic that is supposed to kill the bacteria that lives in clogged pores. It was partially effective, although I found out the hard way that you need to always take doxcycline with food, or the capsules will get stuck to the stomach lining and cause an ulcer.
I also used Retin-A on my face to reduce clogged pores. While that reduced the amount of acne on my face, I got deep cystic acne on my back and chest -- the kind where white cysts form under the skin after the acne heals. Retin-A didn't seem to help that, and it would require a lot of Retin-A to treat my face, upper back.
At 17, my parents sent me to a local Dermatologist for an Accutane consultation, and she put me on Accutane. Taking Accutane entails monthly blood draws to see if Accutane is causing problems with liver functions. I was also taking a recently-FDA approved allergy medication, and the combination elevated my liver functions above normal levels enough for my doctor to stop Accutane after about 4 months, which was a little on the short side of a normal course. That short course of Accutane didn't cure my cystic acne, so I went back on Accutane for a full 6 month course once my liver functions went back to normal. That time I was only taking Accutane, and my liver functions remained within the normal range.
Accutane has some nasty side effects - initially, it does make acne worse, and by reducing oil production it causes dry skin and in my experience, stiffer joints. It only partially reduced the shallower acne I had on my face, but it did seem to cure the deep cystic acne I had previously.
In hindsight, I wish I had started Accutane like my friend did at 13 -- it would have prevented 4 years of cystic acne. 10 years after taking Accutane, I've learned to use a 2% salicylic acid astringent to treat the whiteheads and blackheads that Accutane didn't cure.