Accutane works by giving your body an overdose of Vitamin A which helps to tighten your pores, reduces sebum production and makes your skin much drier. It also has some anti-inflammatory properties which might help with your hyperpigmentation. Since it makes your skin drier and weaker so you will be more susceptible to sun damage (USE SUNSCREEN!) and eczema. Moisturizer is an essential part of the Accutane journey.
I've been on Accutane for about month now and I've been lucky enough not to experience too many side effects like sore joints, eye changes and back pain but like most people dry skin, chapped lips and nosebleeds have been my main concerns. Accutane really is a miracle drug and in 90% of cases, people have been very happy with their results after treatment. It's also a post-acne treatment meaning after you finish your dosage, your acne will not return for a while.
If you feel like your acne is bothering your self-esteem like it has with me then Accutane is definitely worth it. Already about 1.5 months in my ance is starting to improve greatly. If you stick with your treatment then you will get results.
If you are really worried about the side effects which affect some people and don't affect others then don't take it. Some of them can be life-long even.
Hope this helps,