Stieva-A Cream contains the active ingredient tretinoin USP in 0.01%,
0.025%, 0.05% and 0.1% concentrations.
Tretinoin is structurally and pharmacologically related to Vitamin A, which
regulates epithelial cell growth and differentiation.
Tretinoin, when applied topically, acts to stimulate mitosis in the
epidermis and to reduce intercellular cohesion in the stratum corneum.
Tretinoin contests the hyperkeratosis characteristic of acne vulgaris and
aids desquamation, preventing the formation of lesions. Tretinoin also
mediates an increased production of less cohesive epidermal sebaceous cells,
which consequently flow out of the follicle at a more rapid rate. This
appears to promote the initial expulsion and subsequent prevention of
comedones, which are composed of thickened sebaceous cellular debris.
Indications and Uses
Stieva-A is indicated for use in the treatment of acne vulgaris, in
particular forms where comedones, papules and pustules predominate. It is
not generally effective in most cases of severe pustular or nodulocystic
Route of Administration
For topical application only.
Stieva-A should be applied once daily before retiring to the whole area
under treatment. The skin should be thoroughly cleansed and dried before
Therapeutic effects may not be seen until 8-10 weeks after the start of
treatment. Treatment should normally be continued for three months.
Patients being treated with Stieva-A may continue to use cosmetics.
Patients with known hypersensitivity to any of the ingredients should not
Stieva-A has been reported to cause severe irritation of eczematous skin
and should only be used with the utmost caution in patients with this
Stieva-A should not be used in patients with a personal or family history
of cutaneous epithelioma.
Use in Pregnancy and Lactation
Studies in animals have shown that oral tretinoin is foetotoxic in rats
given 500 times the topical human dose and teratogenic in rats given
1000 times the topical human dose. Topical tretinoin has caused delayed
ossification in a number of bones in the offspring of rats and rabbits
given 100 to 320 times the topical human dose respectively. Isolated
cases suggesting a possible link between use of topical tretinoin during
pregnancy and birth defects have been reported, although a case-control
study showed no such association. Use of topical tretinoin is not
recommended during pregnancy, especially during the first trimester.
Precautions and Warnings
Avoid contact of Stieva-A with the eyes, eyelids, mouth and other mucous
membranes and with the angles of the nose and nasolabular fold.
Avoid excessive application.
Studies have shown that in mice treated with tretinoin and exposed to UV
light, tretinoin may speed up the appearance of tumours induced by UV light
(artificial sunlight); mice treated with tretinoin but not exposed to the
light did not develop tumours. The significance of these findings as related
to human beings is unknown. Exposure of areas treated with Stieva-A to
sunlight should be avoided or minimised. The use of sunlamps should be
avoided during treatment.
Initial application may cause a transient stinging and feeling of warmth.
The correct frequency of application will produce a slight erythema similar
to sunburn. If Stieva-A is applied excessively, marked redness or peeling
and irritation may occur. In such cases the frequency of application should
be reduced or treatment interrupted.
Temporary hyper-pigmentation and hypo-pigmentation have been reported
following the use of tretinoin preparations.
All side effects so far reported have been reversible on discontinuation
of therapy and in many cases did not recur on reinstitution of treatment
Excessive topical use: Discontinue use of Stieva-A, apply emollients
Ingestion: Unless the quantity ingested is small, gastric lavage
should be used.
Concomitant topical medication, medicated or abrasive soaps and cleansers,
soaps and cosmetics that have a strong drying effect, and products with high
concentration of alcohol, astringents, spices or lime should be used with
caution because of possible interaction with tretinoin.
Particular caution should be exercised when using preparations containing
a peeling agent (for example sulphur, resorcinol, benzoyl peroxide or
salicylic acid). It may be advisable to 'rest' a patient's skin until the
effects of previously used peeling agents subside before initiating Stieva-A
No reports on incompatibilities with this drug.
Stieva-A Cream is supplied in epoxy-lined aluminium tubes of 25g capacity.
The tube is presented in a carton with a package insert.
Stieva-A should be stored at temperatures not exceeding 25°C.