Posted on Fri, Dec 09, 2011
By Marné CarMicha Walsh, M.S., P-AC
Winter is just around the corner with cooler temperatures and wetter days. Many people let their sunscreens fall to the wayside thinking they don’t need the protection during this season. They couldn’t be more wrong. Ultra-violet radiation is only reduced by 20% on a cloudy day. Temperature is irrelevant as seen in colder climates. Don’t you remember getting sunburned or the “raccoon-face” tan the first time you went skiing?
Still, some are concerned that they won’t get enough Vitamin D. I can understand their concern given the media hype over Vitamin D deficiency and the long list of ailments and diseases that seem to result. The bottom line is that you should never use the sun as your source of Vitamin D. Supplements and dietary sources are much safer. Of the supplements, Vitamin D3 is the best form for absorption. Good sources of dietary Vitamin D include fish, eggs, liver, shiitake mushrooms and fortified dairy products. The FDA recommends that children take 400iu per day and healthy adults take 800iu per day.
How do I know if I might be at risk for Vitamin D deficiency?
Conditions such as fat malabsorbtion problems (i.e. cystic fibrosis,etc.), post-gastrectomy or gastric bypass, celiac disease, chronic pancreatitis, lactose intolerance, HIV malabsorption, or patients such as the elderly who almost never get outside, should have their Vitamin D levels checked and corrected accordingly. If you suspect that your vitamin D levels are low, getting a simple blood test can determine if you are deficient.
In Hawaii, we get more year-round UV radiation, and therefore, more Vitamin D than most places in the US. I recommend that if someone insists on getting their Vitamin D dose from the sun, that they get it on parts of their body that are usually NOT sun exposed such as the abdomen or upper thighs. Other areas such as the face, shoulders, chest and arms should be protected during this time and daily. It is also better to get a small amount of sun daily (10-15 minutes is sufficient) than a large and lengthy dose of UV radiation. So, protect yourself in the winter months from UV radiation and if you think you are not getting enough Vitamin D, take a supplement, not a suntan!
Not sure which sunscreen is right for your lifestyle? Need a sunblock with Zinc or a high SPF sunscreen for water sports? Visit our sunscreen bar in Waimea for a full selection of products that provide the ultimate in skin protection including Obagi and Skinceuticals.
Posted on Fri, Oct 21, 2011
By Marné CarMicha Walsh, M.S., P-AC
I’ve heard this request many times from patients wanting to look younger instantly with the use of a “magic cream” that they can apply at home. I think it is important to first look at the cause of skin aging. We know that aging skin is multi-factorial, involving both intrinsic and extrinsic factors. Intrinsic factors are the genetic program of our cells and the way that they naturally age. As we age, it is natural for collagen and elastin to break down. Unfortunately, our body does not automatically regenerate the lost collagen unless there is skin trauma. Extrinsic factors are environmental effects like tobacco, photo-aging (sun radiation), chemicals (air pollution or exposure), diet, etc.
You have control over extrinsic factors
We cannot change our genetics, therefore, most topical treatments focus on protecting us from the extrinsic factors. We know that tobacco smoking and sun exposure are the 2 most powerful skin aging accelerators. As a result, the cosmeceutical industry has expanded their product lines to include all variations of sunscreen, anti-aging creams and antioxidants—some effective, some not. Physician offices are in a unique position to choose effective products as we have the knowledge base to evaluate products, review the medical studies and access national conferences to discuss the products and ingredients with one another.
Is sunscreen an anti-aging cream?
I often half-joke with my patients that the best anti-aging cream is zinc sunscreen applied liberally and daily as well as sun avoidance. Here in Hawaii, it is difficult to avoid the sun. We need to cover up and reapply sunscreen more often as well as avoid the sun when possible. That means standing in the shade when available, limiting outdoor activities during the hours of 10am-2pm (when the sun’s UV radiation is at its strongest), wearing sun protective clothing such as UPF 50 long sleeve shirts and hats, as well as generous reapplication of sunscreen every 2 hours (more often if sweating or in the water).
How much sunscreen we apply is just as important as how often. A shot glass size amount is recommended to cover the body of an average size person for one application. Wearing a long sleeve UPF 50 shirt would reduce the amount of sunscreen needed to cover the body by 40-50%! As for the face, don’t depend on that SPF 15 found in your moisturizer. Choose one that has at least 5% zinc oxide. If you use a moisturizer, apply it first, followed by your sunscreen. If you have oily skin, use an oil-free zinc and titanium formulation. Some sunscreens are tinted to balance the red and give light coverage. No matter which one you choose, make sure to allow time for the sunscreen to dry on your skin before applying make-up.
Protect your skin from free-radicals…
Although sunscreens such as zinc and titanium can reflect a good portion of the damaging UVradiation that ages our skin, some radiation still trickles through. This amount increases with time as the sunscreen weakens or rubs off. Topical antioxidants can protect the live skin cells from free radical accumulation in the skin as well as protect the skin from sunburn. Free radicals from both the sun and environment accumulate in our skin cells and alter the DNA. This results in accelerated breakdown of collagen and elastin fibers, the backbone of firm skin. Vitamin C and E, coffee berry, ferulic acid, plant phloretins, and green tea are some of the most widely used and studied antioxidants on the market today.
I recommend applying a combination of at least two or three antioxidants every morning directly on clean skin. Don’t worry, that doesn’t mean you will have 3 different bottles. Antioxidants are usually formulated with several different components in the same bottle. Some antioxidants, such as Vitamin C, can offer long lasting protection even in the water.
Look for part 2 of this blog post where I will discuss specific wrinkle cream ingredients and formulations such as Tretinoin (Retin-A), Renova, Retissa, Peptides, and Human Growth Factors.
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Posted on Tue, Oct 11, 2011
By Bayardo Aviles
This is part two of my blog post on Obagi sunscreens where I continue my review of Obagi sunscreen products. As I said in the first part of the blog post, I have had the opportunity to use all of the Obagi sunscreens since I started using Obagi products 13 years ago, so I am speaking from my own personal experience. As promised, I will also answer the second most frequently asked question about Obagi sunscreen products that I get from my regular Obagi patients, "Why is my friend using a different Obagi sunscreen than me?"
Sun Shield SPF 50
Obagi Nu-Derm Sun Shield SPF 50. A sunscreen that
combines high UVB absorption 
and dynamic UVA blockage in an elegant, matte finish with 10.5% zinc oxide and 7.5% octinoxate. Non-whitening, PABA-free, and fragrance-free for all skin types.
This is Obagi’s newest sunscreen. I actually used it today for my drive home. I was able to get out of the office early and the sun was still shining so I ran into my office and applied this sunscreen. It goes on very light and although it has a substantial amount of zinc oxide (10.5%) it goes on clear. What I liked about it is that it has a matt finish and so my face does not look oily. I think this will be a great option for patients with oily skin. The matte finish hides the oily shine. I would not recommend it to patients that are looking for a moisturizing sunscreen. I will keep trying this one and it may become a favorite since I have oily skin.
Obagi Rosaclear Skin Balancing Sun Protection SPF 30
This sunscreen was formulated for patients with rosacea and facial redness. It is very similar in composition to the Physical SPF 32 in the Nu-Derm line. It contains 15.5% zinc oxide and 2% titanium dioxide.
Both of these ingredients are very gentle and do not irritate the skin. To camouflage some of the redness associated with rosacea, a tint was added to this sunscreen. However, the tint does not look good on brown Hispanic, Hawaiian and Filipino skin. It makes the skin look reddish white. Not a good look on dark tanned skin, but it is great for patients with fair skin. This sunscreen is very dear to me since it was my chosen sunscreen when I hiked Mt. Killimanjaro and on an African safari last March. You can go to our Facebook page for Cosmetic Centers of Hawaii to see some of my pictures and see what I mean about the white/reddish face. The best thing is that it kept me protected and I did not get a sunburn.
C-Sunguard SPF 30
Contains 9% micronized zinc oxide and 7.5% octinoxate.
Prevents premature aging
from UVA/UVB radiation. Protects skin radiance.
This sunscreen was introduced as part of the Obagi C Rx line. This line was introduced a few years back to target patients that were looking for a product line that was better than the over the counter products they were using but not as aggressive as the Obagi Nu-Derm, Obagi’s corrective skincare system. This product line is simple to use and the products contain hydroquinone for skin lightening, alpha- hydroxy acids for exfoliation and Vitamin C for protection. The sunscreen in this skincare line looks and feels exactly like the Healthy Skin SPF 35, except you can smell the Vitamin C. This product is moisturizing and it goes on the skin very nicely. However, your skin may look a bit shiny for the first 5 minutes while the products are penetrating. I recommend this sunscreen a lot for people that are outside a lot because of the added protection of the Vitamin C. Vitamin C is an anti-oxidant that protects the skin from free radicals formed as a result of sun exposure.
Why is my friend using a different Obagi sunscreen than me?
When I perform a skincare consultation I try to find out as much as possible about the lifestyle of the patient as I can. This helps me determine which sunscreens to recommend. When a patient starts the Obagi Nu-Derm system, pretty much everyone starts with the Sunfader, since most patients are trying to improve some type of discoloration. Or for patients that are in the sun a lot, I then recommend an additional sunscreen. Which sunscreen I select, mainly depends on the skin type and skin color of the patients. Typically, the Healthy Skin SPF 35 and the C-Sunguard SPF 30 are the most popular. For patients that are very sensitive to the sun and are trying to remove discoloration caused mainly by hormonal influences (Melasma) I recommend the SPF 32. For patients with oily skin, I now recommend the Sun Shield SPF 50.
I hope this document clarifies some of questions you may have had about the different Obagi sunscreens that we carry in our practice. You may also want to visit the new Sunscreen Bar in our Kamuela office. There you can feel, smell and test about 20 of the best sunscreens in the market.
Posted on Fri, Oct 07, 2011
By Bayardo Aviles
My regular Obagi patients frequently ask me two main questions about Obagi sunscreens:
1. What is the difference between the different Obagi sunscreens?
The easy answer to question one would be to give you a list of the main ingredients for you to read, but that does not help much. At least it would not help me. Fortunately, I have had the opportunity to use all of the Obagi sunscreens since I started using Obagi products 13 years ago. Here, I will share my personal opinion of them. However, please remember that we all have different taste and that different lotions look and feel better on different skin types, so do not use only my opinion to make a decision if a specific sunscreen is adequate for you. For each sunscreen I will give you a technical description (main active ingredients) followed by my personal experience.
Obagi Nu-Derm Sunfader SPF 15 (6)
A topical prescription treatment that helps to protect skin from ultraviolet damage with 7.5% octinoxate and 5.5% oxybenzone, while correcting uneven surface skin color and brown spots with 4% hydroquinone. 2.0 fl ox (57 g).
This is the sunscreen that is included in the Obagi Nu-Derm starter kit. It is an essential component of the Obagi system when trying to remove brown discoloration. It contains 4% hydroquinone to lighten sunspots, acne-caused discoloration or scarring and freckles. After application of this sunscreen, the skin stings a bit since it contain two active chemical ingredients. To alleviate the stinging, I typically use a hand fan and fan for a few seconds until the sensation goes away. For those of you that use the Obagi system, you know that this is the last product you apply in the morning so the skin feels saturated and looks shiny, but it slowly penetrates the skin and your complexion looks better.
Healthy Skin Protection SPF 35
Obagi Nu-Derm Healthy Skin Protection SPF 35 (6). A sunscreen with 9% micronized zinc oxide and 7.5% octinoxate helps to protect newly transformed, younger looking skin.
This is the sunscreen that is included in the Obagi Nu-Derm starter kit as a one-ounce sample. It is recommended to apply this sunscreen after applying the Sunfader SPF 15, especially if you suspect you will be in the sun for an extended period of time. I typically tell my patients to go ahead and apply it all the time since we live in a sunny place and it is better to prevent. This is the sunscreen I personally prefer to use on a daily basis. It is moisturizing, goes on my skin smoothly and it gives me great protection without leaving my skin too white since the zinc oxide is micronized (very finely grounded). Typically, this is one of the sunscreens I recommend once patients enter the maintenance phase of their skin transformation with the Obagi Nu-Derm system.
Physical UV Block SPF 32
Obagi Nu-Derm Physical UV Block SPF 32 (6). A sunscreen with 18.5% zinc oxide helps to protect the newer, healthier skin created by your skin transformation. 2.0 oz (57 g).
This is the sunscreen we recommend the most after any type of moderate to aggressive laser or chemical peel procedure. Because it only contains zinc oxide, it does not irritate my skin at all. This is the sunscreen I use the most when I go to the beach to read or go for a hike. Now, some patients do not like this sunscreen because it contains a lot of zinc oxide (18.5%) and it goes on your skin white and stays white for a while. I do not recommend massaging it too much into the skin because this diminishes the SPF protection. There are other sunscreens available now, with similar zinc oxide and titanium dioxide contents that are tinted and go on the skin more elegantly than the Physical SPF 32, but I still prefer the Physical SPF 32 because I can clearly tell if I missed a spot. This sunscreen is packaged in a very firm plastic container to prevent breakdown of the ingredients and you must have strong hands to squeeze the product out once you get close to the end of the container.
Look for part two of my blog post on Obagi sunscreens next week where I will review a few more Obagi sunscreen products. In that article I will also answer the second most frequently asked question my regular Obagi patients ask. You may also want to visit the new Sunscreen Bar in our Kamuela office. There you can feel, smell and test about 20 of the best sunscreens in the market.
(Read part two of this Obagi sunscreen blog post here)
Posted on Tue, Aug 09, 2011
By Bayardo Aviles
After completing a series of laser treatments or an aggressive skincare program I often get asked by patients to design a simple skincare program that is easy to do and does not have many steps to maintain their new healthy skin. This can be challenging at times since there are so many skin care products available.
During one of my trainings a few years ago, I heard the concept of the basic four and it really stuck with me. The concept of the basic four says that any daily skin care program should have four components to it:
- Topical Anti-oxidant
- Exfoliant
- Condition specific treatment
- Sunscreen
1. Topical Anti-Oxidants
The best way to think of an anti-oxidant is, as an additional form of shielding the skin from sun damage. After applying topical anti-oxidants to the skin for a few days, a reservoir of anti-oxidants is built in the skin. The anti-oxidants are then recalled by the skin to fight free radicals that form as a result of sun exposure and other environmental insults.
The most commonly used anti-oxidant is Vitamin C. We currently offer Obagi Professional -C Serums with pure L-Ascorbic Acid and SkinCeuticals anti-oxidant serums. SkinCeuticals serums contain additional anti-oxidants making them ideal for patients that are exposed to the sun regularly since they provide additional protection. For patients looking for an anti-oxidant in a cream form vs. a serum form, we offer RevaleSkin Day Cream and Night cream with 1% CoffeeBerry®.
2. Exfoliants
Almost every time I mention this to patients, they tell me they use a facial scrub once or twice a week to exfoliate. Although using a physical exfoliant (scrub) is not a bad idea, it can be very harsh for some skin types, especially for acne patients since it can cause more inflammation therefore making acne worse.
When I recommend exfoliants, I am mainly referring to lotions or topical exfoliants. These are products that you use regularly and are left on the skin throughout the day or night so the next time you wash your face the dead skin cells are easily removed leaving behind a smooth brighter surface.
Also, topical exfoliants not only remove surface dead skin cells, they penetrate deeper into the skin to unclog pores. The most common exfoliants are alpha-hydroxy acids or AHAs, retinols, Retin A. This is similar to doing a very gentle chemical peel on a daily basis to remove dead skin and expose new younger skin to the surface. An often overlooked benefit of exfoliation is that it allows for better penetration of skin care products since they do not have to fight their way through layers of dead skin cells.
3. Condition Specific Treatment
On a daily basis we see patients with different skin conditions and needs. Therefore it is almost impossible to have one cream for everyone and every condition. We have treatment creams for rosacea, acne, brown spots, acne blemishes, dry skin, etc.
During your office visit your skincare consultant will make product recommendations specific to your condition and skin type. Patients with multiple conditions, can chose to correct one condition at a time or tackle multiple conditions at once. In some case, we have skincare products that can improve 2 or 3 conditions at the same time.
4. Sunscreen
This is the most crucial step. I am very blunt about this one. If you do not protect your new skin after facial treatments why waste the time and money. The best sunscreen to me is the one you will use. We get so fixated on, “what is the best sunscreen out there,” but then we do not use it because: it is too oily, too white, smells like sunscreen, makes me break out, I look shiny, etc., etc.
I tell patients to find one that they like and stick to it. We recently introduced the concept of a sunscreen bar in our Kamuela office. There you can feel, smell and test about 20 of the best sunscreens in the market. Also remember that you must have different sunscreens for different occasions. For example, if you do a lot of yard work on the weekends, you may need a different sunscreen than the one you need for work in an office. We will make sunscreen recommendations based on your skin type and lifestyle.
Find out what impact your lifestyle has had on your skin. For a personalized skin care consultation, I invite you to schedule a complementary VISIA skin care analysis at any of our three office locations.
Posted on Tue, Jul 05, 2011
By Marné CarMicha Walsh, M.S., P-AC
I created a favorite picks list for sunscreen products that we carry in our office. All of these products contain zinc oxide and provide true broad-spectrum sunscreen coverage (Full UVB and UVA).
Avoid products with partial protection
Most chemical sunscreens provide only partial UVB and/or partial UVA protection, therefore multiple chemical sunscreens are needed in a single product in order to achieve broad-spectrum UVB and UVA coverage. Unlike chemical sunscreens that can be absorbed into the body, zinc is safe to use on young children because it is not absorbed into the body. Many of the sunscreens in our office are paraben-free and fragrance-free and we also carry oil-free formulations ideal for acne prone skin.
All of our favorite picks are featured on our new sunscreen bar here at the Waimea office with sample bottles available so you can decide what feels and looks the best on you! Our staff is also available to answer your questions and help you choose the right sunscreen.
Favorite picks list
All contain Zinc oxide for true broad-spectrum protection
| Water Sports: |
Face: |
TiZo3 facial mineral fusion |
| |
|
Planet Sun Stick |
| |
Body: |
Skinceuticals Sport Defense |
| |
|
TiZo3 Body |
| |
|
Planet Sun Lotion |
| |
|
Elta MD UV Sport |
| Heavy Sweating: |
Face: |
TiZo3 facial mineral fusion |
| |
|
Skinceuticals Sport Defense |
| |
|
Planet Sun Stick |
| |
|
Epicuran Active Sport Treat |
| |
|
Elta MD UV Sport |
| |
Body: |
Skinceuticals Sport Defense |
| |
|
Planet Sun Lotion |
| |
|
Epicuren Active Sport Treat |
| |
|
Elta MD UV Sport pump |
| |
|
Elta MD UV Spray |
| Daily oily facial skin/acne: |
|
Skinceuticals Physical Fusion (tinted) |
| |
|
Skinceuticals Sheer Defense (not tinted) |
| |
|
Obagi Sunshield |
| |
|
Jane Iredale Powder-me SPF Dry Sunscreen |
| |
|
PCA protecting Hydrator |
| |
|
Obagi Rosaclear Skin Balancing Sun Protection |
| Daily dry to normal skin: |
|
Skinceuticals Ultimate Defense |
| |
|
Skinceuticals Physical UV Defense |
| |
|
Obagi Nuderm Healthy Skin Protection |
| |
|
Obagi C-Sunguard |
| |
|
Epicuran Zinc Oxide |
We have many new products that will keep you safe in the sun this summer and beyond, and we can advise you how to choose what will work best for you. We have a product for your skin type, including sunscreens for acne-prone skin.
Skinceuticals Physical Fusion UV Defense 50? EltaMD UV Sport SPF 50? Or Planet Sun Stick? Or something else? What is your favorite sunscreen product?
Posted on Fri, Jul 01, 2011
By Marné CarMichael Walsh, M.S., P-AC
When I go to the store, especially the larger ones like Walmart, I often glance at their sunscreen selection. It seems to constantly change and grow in the number of choices. If I feel overwhelmed, what are our patients feeling? For me, I know what to look for under “active ingredients” and I am shocked at how the labeling has gotten out of control.
Beware of false labeling on sunscreen products
New FDA recommendations were recently released to help control false labeling and claims but it is still not enough. Below is a summary of the proposed changes put forth by the FDA in June 2011:
- The final regulation allows sunscreen products that pass the FDA’s test for protection against both ultraviolet A (UVA) and ultraviolet B (UVB) rays to be labeled as “Broad Spectrum.” Both UVB and UVA radiation contribute to sunburn, skin cancer, and premature skin aging. Sunburn is primarily caused by UVB radiation.
- Under the new labeling, sunscreens labeled as both Broad Spectrum and SPF 15 (or higher), if used regularly, as directed, and in combination with other sun protection measures will help prevent sunburn, reduce the risk of skin cancer, and reduce the risk of early skin aging.
- Products that have SPF values between 2 and 14 may be labeled as Broad Spectrum if they pass the required test, but only products that are labeled both as Broad Spectrum with SPF values of 15 or higher may state that they reduce the risk of skin cancer and early skin aging, when used as directed.
- Any product that is not Broad Spectrum, or that is Broad Spectrum but has an SPF between 2 to 14, will be required to have a warning stating that the product has not been shown to help prevent skin cancer or early skin aging.
Additional FDA regulatory documents
Subsequently, three additional proposals were released by the FDA. They include limitations on the maximum SPF values, an Advance Notice of Proposed Rulemaking (ANPR) for Dosage Forms, and a Draft Enforcement Guidance for Industry.
- The proposed rule would limit the maximum SPF value on sunscreen labels to “50 +”, because there is not sufficient data to show that products with SPF values higher than 50 provide greater protection for users than products with SPF values of 50. The proposal creates the opportunity for the submission of data to support including higher SPF values in the final rule. FDA looks forward to receiving public comment on this document.
- The ANPR will allow the public a period of time to submit requested data addressing the effectiveness and the safety of sunscreen sprays and to comment on possible directions and warnings for sprays that the FDA may pursue in the future, among other issues regarding dosage forms for sunscreens.
- The Draft Enforcement Guidance for Industry outlines information to help sunscreen product manufacturers understand how to label and test their products in light of the new final rule and other regulatory initiatives.
Since most skin cancers are caused by sun exposure, the FDA encourages consumers to protect themselves by regular application as well as reapplication of sunscreens with broad spectrum protection and SPF of 15 or higher. Here in Hawaii, I recommend an SPF of at least 30.
Suncreen facts you should know:
- The FDA is working to control false labeling and claims on sunscreen products
- In Hawaii, a sunscreen with an SPF of at least 30 should be used
- Zink oxide provides true broad-spectrum coverage
Watch for my next blog article where I will post my list of favorite picks for sunscreen products that we carry in our office. All of these products contain zinc oxide and provide true broad-spectrum sunscreen coverage (Full UVB and UVA).
Posted on Fri, May 06, 2011
Dr. Stover and his staff occasionally answer skin care questions from fans of the Cosmetic Centers of Hawaii Facebook Page. Here are two recent questions. The first is a facial skin care question from Michael T. who asks:
"I had to moisturize my face when on the mainland. Don't seem to need it here on the Big Island. Why is that?"
Michael, it has to do with the humidity. Hawaii ranges 
between 60-100% humidity (moisture in the air). The mainland, especially areas near the dessert, can commonly be as low as 0%. Thus, the dry air will make the water in one's skin evaporate more readily requiring us to apply more moisturizer. Humid air like in Hawaii, will have less of an evaporative effect. In fact, the humid air can make our skin feel "sticky" – not from sweat but from the moisture in the air that settles on our skin.
The second question comes from Kami C. who wants to know more about the controversy over: "Sunscreen vs. vitamin D deficiency...."
Background
The body needs sunlight in order to produce vitamin D, an important nutrient. But a few studies have found that 
sunscreen limits the production of Vitamin D. Other recent studies say that yes, sunscreen does hamper Vitamin D production, but not enough to cause a deficiency. So what is the bottom line?
Supplements not more sunshine are the way to go
Kami, as far as Vitamin D, in Hawaii, we get more than the recommended 10-15 min/day by driving, sitting near an open window, or getting in/out of cars. If someone insists on getting more, I recommend getting it on areas that are not usually sun exposed on a daily basis (abdomen, legs) since the face, lower arms and neckline get sun daily. If you are vitamin D deficient, taking Vitamin D supplements is recommend over getting sun exposure.
What about darker skin?
It is true that darker skin patients will absorb less vitamin D
than fairer skinned patients. However, in Hawaii, the UV index is much stronger and we tend to spend more time outdoors and with less clothing year round compared to any other state on the continental US. If someone is worried about vitamin D, it is always safer to take a supplement such as that found in Calcium supplements rather than increasing the time spent in the sun. There is no sunscreen that is 100% and in fact, it is no where close. So, even with sunscreen, we are getting UV radiation and stimulating Vitamin D production in our bodies.
By Marné CarMichael Walsh, M.S., PA-C
Cosmetic Centers of Hawaii
At the Cosmetic Centers of Hawaii, Ms. CarMichael Walsh, a certified physician assistant, supports Dr. Stover in diagnosing and treating a variety of skin conditions including acne, eczema, psoriasis, rosacea, moles, warts, skin tags and skin rashes. To schedule a general skin exam, which includes a thorough examination of the skin and recommended skin care treatment options, contact Dr. Stover's office for an appointment.