I had horrendously bad acne for years. (Face, back, chest...ugh.) My dermatologist kept putting me on creams like Retin-A or Differin that didn't work, but just made me red and peely. Finally I quite my dermatologist and went to my doctor, who put me on Accutane. I swear by it. I was on Accutane for 8 months and it cleared me up completely. Now I almost never get breakouts (only if I'm super stressed and haven't slept for a long time), and even then they're pretty minor breakouts.
As for the side effects, I used Cetaphil lotion, which is odorless, light, and doesn't clog your pores. When I used that, I didn't peel. Also, I took Accutane from September-April. During the winter there's generally less exposure to sunlight and sunburns/sensitive skin isn't much of a problem. But whenever I went outside I put on a bit of sunscreen and I was fine. I also got nosebleeds more frequently, but if you put some lotion up each nostril, you should be fine.
Other than that, I didn't experience any side effects. And I got monthly blood tests to check my liver and whatnot (required before receiving the next monthly dosage).
I wouldn't recommend Accutane for just anybody who has acne...it's a pretty strong medication. It's more like a last resort for the really stubborn stuff. But, God, does it work.