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Not so long ago, a friend texted me from a coffee shop. He said, "I can't believe it. I'm the only one here without a tattoo!" That might not seem surprising: a quick glance around practically anywhere people gather shows that tattoos are widely popular.

Nearly one-third of adults in the US have a tattoo, according to a Pew Research Center survey, including more than half of women ages 18 to 49. These numbers have increased dramatically over the last 20 years: around 21% of US adults in 2012 and 16% of adults in 2003 reported having at least one tattoo.

If you're among them, some recent headlines may have you worried:

              Study Finds That Tattoos Can Increase Your Risk of Lymphoma (OnlyMyHealth)

              Getting a Tattoo Puts You At Higher Risk of Cancer, Claims Study (NDTV)

              Inky waters: Tattoos increase risk of lymphoma by over 20%, study says (Local12.com)

              Shocking study reveals tattoos may increase risk of lymphoma by 20% (Fox News)

What study are they talking about? And how concerned should you be? Let's go through it together. One thing is clear: there's much more to this story than the headlines.

Why are researchers studying a possible link between tattoos and lymphoma?

Lymphoma is a type of cancer that starts in the lymphatic system, a network of vessels and lymph nodes that twines throughout the body. With about 90,000 newly diagnosed cases a year, lymphoma is one of the most common types of cancer.

Risk factors for it include:

• advancing age
• certain infections (such as Epstein-Barr virus, HIV, and hepatitis C)
• exposure to certain chemicals (such as benzene, or possibly pesticides)
• family history of lymphoma
• exposure to radiation (such as nuclear reactor accidents or after radiation therapy)
• having an impaired immune system
• certain immune diseases (such as rheumatoid arthritis, Sjogren's disease, or celiac disease).

Tattoos are not known to be a cause or risk factor for lymphoma. But there are several reasons to wonder if there might be a connection:

• Ink injected under the skin to create a tattoo contains several chemicals classified as carcinogenic (cancer causing).
• Pigment from tattoo ink can be found in enlarged lymph nodes within weeks of getting a tattoo.
• Immune cells in the skin can react to the chemicals in tattoo ink and travel to nearby lymph nodes, triggering a bodywide immune reaction.
• Other triggers of lymphoma, such as pesticides, have a similar effect on immune cells in lymph nodes.

Is there a connection between tattoos and lymphoma?

Any potential connection between tattoos and lymphoma has not been well studied. I could find only two published studies exploring the possibility, and neither found evidence of a compelling link.

The first study compared 737 people with the most common type of lymphoma (called non-Hodgkin's lymphoma) with otherwise similar people who did not have lymphoma. The researchers found no significant difference in the frequency of tattoos between the two groups.

A study published in May 2024 — the one that triggered the scary headlines above — was larger. It compared 1,398 people ages 20 to 60 who had lymphoma with 4,193 people who did not have lymphoma but who were otherwise similar. The study found that

• lymphoma was 21% more common among those with tattoos
• lymphoma risk varied depending on how much time had passed since getting the tattoo:
  • within two years, lymphoma risk was 81% higher
  • between three and 10 years, no definite increased lymphoma risk was detected
  • 11 or more years after getting a tattoo, lymphoma risk was 19%

There was no correlation between the size or number of tattoos and lymphoma risk.

What else should you know about the study?

Importantly, nearly all of the differences in rates of lymphoma between people with and without tattoos were not statistically significant. That means the reported link between lymphoma and tattoos is questionable — and quite possibly observed by chance. In fact, some of the other findings argue against a connection, such as the lack of a link between size or number of tattoos and lymphoma risk.

In addition, if tattoos significantly increase a person's risk of developing lymphoma, we might expect lymphoma rates in the US to be rising along with the popularity of tattoos. Yet that's not the case.

Finally, a study like this one (called an association study) cannot prove that a potential trigger of disease (in this case, tattoos) actually caused the disease (lymphoma). There may be other factors (called confounders) that are more common among people who have tattoos, and those factors might account for the higher lymphoma risk.

Do tattoos come with other health risks?

While complication rates from reputable and appropriately certified tattooists are low, there are health risks associated with tattoos:

• infection, including bacterial skin infections or viral hepatitis
• allergic reactions to the ink
• scarring
• rarely, skin cancer (melanoma and other types of skin cancer).

The bottom line

Despite headlines suggesting a link between tattoos and the risk of lymphoma, there's no convincing evidence it's true. We'll need significantly more research to say much more than that. In the meantime, there are more important health concerns to worry about and much better ways for all of us to reduce cancer risk.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

As the adage goes, the eyes are the windows to the soul. So what does it mean to wish yours were a different color?

Apparently enough people share this desire to create a bustling market for color-changing eye drops, which are making the rounds through social media and online retailers.

Personalizing eye color might sound tempting, especially for younger people and those who enjoy experimenting with elements of fashion or style. But are over-the-counter, color-changing eye drops safe? The answer is a hard no, according to the American Academy of Ophthalmology (AAO), which recently issued a warning against “eye color-changing solutions.”

Why shouldn’t you try color-changing eye drops?

Color-changing eye drops aren’t approved by the FDA, haven’t been tested for safety or effectiveness, and could potentially damage people’s eyes, the AAO warns.

“It might seem benign when you see a product like this online,” says Dr. Michael Boland, an associate professor of ophthalmology and glaucoma specialist at Harvard-affiliated Mass Eye and Ear. “People think, ‘Why not try it?’.” “But there’s no way to know what’s in these bottles and no oversight over how they’re being made.”

How do the eye drops work?

That’s not clear. Companies manufacturing the drops claim the products adjust levels of melanin in the iris, the colored portion of the eyeball. Purportedly, the effects begin to be visible within hours and can last for a week or longer. If a user wants enduring results, they’ll need to continue using the product.

But these claims skirt a complete lack of evidence that the drops have any effects on the iris, much less the desired effects, Dr. Boland says.

“I’ve found zero descriptions of how they work in terms of a plausible mechanism,” he says. The ingredients list includes things that might be found in other eye drops or drugs or even cosmetics, but nothing that would actually change your eye color.”

How might the drops hurt your eyes?

The AAO lists a variety of potential safety risks from using these products or any other unregulated eye drops, including:

• inflammation
• infection
• light sensitivity
• increased eye pressure or glaucoma
• permanent vision loss.

“All of those problems are possible, since we don’t have any real idea what’s in these bottles,” Dr. Boland says. “The biggest concern is damage to the cornea, the clear part of the front of the eye. If the cornea is damaged by the chemicals in those bottles, you might lose vision.”

Are there safe alternatives to change eye color?

Still hankering for a way to get, say, Taylor Swift’s electric blue eyes or Julia Roberts’ golden brown peepers? There is a trustworthy option, Dr. Boland says: colored contact lenses. But he recommends choosing that option with caution.

“Professionally prescribed and dispensed contact lenses are a safe way to change your eye color,” he says. “But don’t buy them online. Get them from a reputable source to make sure they’ve been regulated and evaluated as safe, because contacts can damage the eye if they’re not designed properly or kept clean.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

It’s an unfortunate reality: all medicines can cause side effects. While there are a few tried-and-true ways to deal with drug side effects, here’s a less common option to consider: adding a second medication.

That’s the approach taken with valbenazine (Ingrezza), a drug approved for a condition called tardive dyskinesia that’s caused by certain medicines, most of which are for mental health. Let’s dive into what TD is, how this drug is advertised, and what else to consider if a medicine you take causes TD.

What is tardive dyskinesia?

Tardive dyskinesia (TD) is a condition marked by involuntary movements of the face or limbs, such as rapid eye blinking, grimacing, or pushing out the tongue. TD is caused by long-term use of certain drugs, many of which treat psychosis.

TD may be irreversible. Early recognition is key to improvement and preventing symptoms from getting worse. If you take antipsychotic medicines or other drugs that can cause TD, tell your prescribing health care provider right away about any worrisome symptoms.

A sidewalk sale, a cookout in the park, and a pitch

One ad for Ingrezza starts with a young man working with customers at a sidewalk sale. Though his mental health is much better, he says, now he’s suffering with TD, a condition “that can be caused by some mental health meds.” A spotlight shines on his hands as he fumbles and drops an instant camera he’s selling. He seems embarrassed and his customers look perplexed.

Next we see a young woman at a cookout in a park. The mysterious spotlight is trained on her face as she blinks and grimaces involuntarily. Her voiceover explains that she feels like her involuntary movements are “always in the spotlight.”

Later these two happily interact with others, their movement problems much improved. A voiceover tells us Ingrezza is the #1 treatment for adults with TD. The dose — “always one pill, once a day” — can improve unwanted movements in seven out of 10 people. And people taking Ingrezza can stay on most mental health meds.

That’s the pitch. The downsides come next.

What are the side effects of this drug to control a side effect?

As required by the FDA, the ad lists common and serious side effects of Ingrezza, including

• sleepiness (the most common side effect)
• depression, suicidal thoughts, or actions
• heart rhythm problems
• allergic reactions, which can be life-threatening
• fevers, stiff muscles, or problems thinking, which may be life threatening
• abnormal movements.

That’s right, one possible side effect is abnormal movements — a symptom this drug is supposed to treat!

What the ad gets right

The ad

• appropriately highlights TD as a troubling yet treatable condition that can cause stress and embarrassment and affect a person’s ability to function
• emphasizes once-daily dosing, presumably because the recommended frequency of a competitor’s drug for TD is twice daily
• shares clinical studies that support effectiveness claims
• covers many of the most common and serious side effects.

What else should you know?

Unfortunately, the ad skims over — or entirely skips — some important details. Below are a few examples.

Which medicines cause TD?

We never learn which medicines can cause TD (especially when used long-term), which seems vital to know. Many, but not all, are used to help treat certain mental health disorders, such as schizophrenia or bipolar disorder. Here are some of the most common.

Mental health medicines:

• haloperidol (Haldol)
• fluphenazine (Prolixin)
• risperidone (Risperdal)
• olanzapine (Zyprexa).

Other types of medicines:

• metoclopramide (Reglan), which may be prescribed for nausea, hiccups, and a stomach problem called gastroparesis
• prochlorperazine (Compazine, Compro), most often prescribed for severe nausea, migraine headaches, or vertigo.

Also, the ad never explains that TD may be irreversible regardless of treatment. Because improvement is most likely if caught early, it’s important for people taking these medicines to check in with their health provider if they notice TD symptoms described above — especially if symptoms are growing worse.

What about effectiveness and cost?

Seven in 10 people reported that their symptoms improved, according to the ad. How much improvement? That wasn’t shared. But here’s what I found in a key study:

• Among 202 study participants with TD, only 24% reported having minimal or no symptoms of TD after six weeks of treatment with Ingrezza.
• Up to 67% of study subjects reported smaller improvements in symptoms.

What happens after six weeks? A few small follow-up studies suggest that some people who continue taking Ingrezza may improve further over time.

And the cost? That’s also never mentioned in the ad. It’s about $8,700 a month. No details on the financial assistance program, or who qualifies for free treatment, are provided.

Are there other ways to manage TD?

Well, yes. But the ad doesn’t mention those either. Three approaches to discuss with your healthcare provider are:

• Avoid drugs known to cause TD when other options are available.
• If you need to take these medicines, it’s safest to use the lowest effective dose for the shortest time possible. For example, limiting metoclopramide to less than three months lowers risk for TD.
• If you notice TD symptoms, ask about lowering the dose or stopping the offending drug right away. This may successfully reverse, or reduce, the symptoms.

If you have TD, you and your health care provider can consider several options:

• whether other drug treatments for TD not mentioned in the ad, such as deutetrabenazine (Austedo) or tetrabenazine (Xenazine), might cost less or minimize bothersome side effects
• botulinum toxin injections (Botox), which can relax the muscle contractions causing involuntary movements
• deep brain stimulation, which involves electrical stimulation to certain areas of the brain to interrupt nerve signals to abnormally contracting muscles.

The bottom line

The idea of treating a drug’s side effect with another drug may not be appealing. Certainly, it makes sense to try other options first.

But sometimes there are no better options. It’s always worth asking whether a treatment is worse than the disease. But TD is one situation in which all options — including a drug treatment for another drug’s side effects — are well worth considering.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD