Yes, in severe forms of acne, your treatment may switch to isotretinoin, the active ingredient in roaccutane. However, we rarely start a course with isotretinoin: we always choose the treatment that may have the fewest side effects first. Where you start in the spectrum, from light to heavy treatment, depends on the severity of your acne.
Don't worry, late onset acne is very common and seen mostly in women. The trigger is an excess of male hormones. Many women stop taking the pill that until then has protected them from sebaceous glands. When that protection is removed, androgenic hormones are given leeway and can stimulate the sebaceous glands. In men, there is a better hormonal balance, but supplements can trigger acne later in life.