Yes, for severe forms of acne, your treatment can progress to isotretinoin. However, we rarely start with isotretinoin — we always begin with the option that carries the fewest side effects. Where you start on the spectrum, from mild to intensive treatment, depends on the severity of your acne.
Don’t worry — late-onset acne is very common and is seen especially in women. It’s often triggered by an excess of male hormones. Many women stop taking the contraceptive pill that had previously protected them against blocked sebaceous glands. Once that protection is gone, androgenic hormones have free rein and can stimulate the sebaceous glands. In men, hormonal balance is generally better, but supplements can trigger acne in later life.