A new type of spa is popping up in major U.S. cities. Head spas provide a mix of spa treatments for the scalp and hair as well as potentially therapeutic treatments for dermatologic conditions that affect the scalp. Some head spas offer consultation with a trichology professional, which may include trichoscopic imaging.
Dermatologists say patients are now bringing their trichoscopic images taken at head spas to their office visits, seeking confirmation for their diagnoses. Is the head spa trend – and trichologic evaluations at head spas — helpful in caring for patients with hair and scalp disorders or are there potential drawbacks? An article published in the September Journal of Drugs in Dermatology sought to answer that question.
I interviewed lead author Chandler Johnson, MD, PGY-1 transitional year resident at AdventHealth Redmond in Rome, Ga. In 2026, Dr. Johnson will begin a dermatology residency at the University of South Florida Morsani School of Medicine.
What led you to want to study head spas and the trichologic evaluations provided at some head spas?
I initially became interested about this topic during my role as a clinical research coordinator working under the direction of Dr. Wilson Liao and Dr. Tina Bhutani at the University of California San Francisco Psoriasis Center. While there I had the opportunity to attend a grand rounds given by Dr. Amy McMichael, who mentioned noticing an increase in the number of patients bringing trichoscopy images taken in the community to their dermatology office visits. Around that time, I had begun to appreciate the popularity of head spas within the Bay Area and beyond, with many of these marketing ‘scalp analysis’ and treatment of dermatologic conditions affecting the scalp. I connected with Dr. McMichael to further develop a research inquiry into this topic. We completed this research and analysis with our fellow collaborating authors, Dr. Victoria Palmer and Dr. Maria Hordinsky. We shared the mutual interest in having potential to impact practice when encountering patients who initially sought dermatologic evaluation and treatment in the community at a head spa prior to a visit with a specialist.
You looked at scalp photographs that were obtained from the websites or Instagram social media pages of head spas in New York, Los Angeles, Miami, and Dallas. What were you looking to see, and what did you find?
We were interested in assessing the content, quality, and potentially, even skin changes captured in these scalp photographs. Also, we were interested in assessing the difference in modalities used to complete the ‘scalp analysis’ oftentimes marketed by head spa personnel. We also took interest in evaluating the language included on social media pages and websites used to describe the findings on trichological images.
You discovered that the vast majority of people in the pictures had lightly pigmented scalps. Are you concerned that there may be disparities in care depending on a client’s scalp pigmentation?
Interestingly, the vast majority of photos evaluated had lightly pigment scalps. However, the ethnicities and other demographics of individuals who were captured in the photographs could not be extrapolated from these photos alone. Further analysis needs to be conducted to evaluate the demographics of the clientele seen in the head spas.
Of the 30 head spas included in the study, three listed staff members described as ‘trichology professionals’. What are some concerns about the hair and scalp care provided by those who claim to have expertise in trichology?
Concerns about the hair and scalp care provided by trichologists—non-medical personnel that have received some level of training on human hair and scalp health and disease—centers around lack of standardization of criteria for certification and potential impact of client care. As we discussed in our article, the amount of training for trichology professionals varies drastically between the trichological societies, from a one-day course to a two-and-a-half-year course. There is space for mutual collaboration for the care for patients with dermatologic conditions affecting the scalp between dermatologists and trichology professionals. However, there is concern for delayed or missed diagnosis in patients with potentially irreversible and progressive scalp conditions. This missed opportunity window for dermatology referral could result in prolonged morbidity.
You note that the average lowest to highest price point for head spa services ranged from $103 to $195, and locations with a trichologist had a higher average cost. Is there any value to the services these head spas provide or is this just predatory pricing?
It is reasonable that the price point for head spa services is reflective of the local economies of target cities and also the relative demand for their services in those areas. The concern for predatory pricing arises in the context of services rendered or treatments offered as being definitive or even curative. This is particularly concerning when individuals are being ‘treated’ without substantial evidence about the services or products used as part of a treatment regimen or a definitive diagnosis of what is being treated.
What approach should dermatology clinicians take when a patient brings their trichology photos from a head spa to their dermatology appointment?
To enhance the therapeutic alliance of patients and their providers, it is of the upmost importance to consider the trichology photos that patients have brought with them to their visit. During the course of our study, we did not identify a consistent system used by head spas of marking the location that images were captured from. Despite this, these provided photos should be incorporated into the medical record in conjunction with a thorough history and physical exam. In addition to trichology photos, patients may also come to a dermatology appointment with recommendations or presumed diagnoses from an outside trichologist or spa personnel. Dermatologists must be sensitive while communicating a potential change in diagnosis or new treatment regimen. Disparaging comments about outside trichologist or spa personnel do not have a place in clinical practice; Oftentimes, patients will have long-term relationships and respect for those individuals who they had sought care with before arriving to your clinic. At the same time, dermatologists must be open and direct if their assessment and plan deviate from those the patient had previously encountered.
What do you hope comes from the head spa trend?
Importantly, the head spa trend does draw attention to the importance of scalp health and the reality that dermatologic conditions do affect the scalp, oftentimes with significant impact of patients’ psychosocial functioning. It is through such liaisons with the community and dermatologists that there is enhanced awareness of scalp disease and subsequently a reduction in diagnostic delay. Ideally, further work will be done in the future to train head spa personnel on medical photography so that the trichological images captured can be useful in formal consultations with the board-certified dermatologists.
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