Key points
- Untreated Lyme disease can produce a wide range of symptoms, depending on the stage of infection. These include fever, rash, facial paralysis, an irregular heartbeat, and arthritis.
- Seek medical attention if you observe any of these symptoms and have recently had a tick bite, live in an area known for Lyme disease, or have recently traveled to an area where Lyme disease occurs.
![Circular red rash with central clearing that slowly expands](/lyme/images/rashes/CDC_EM.jpg)
Signs and symptoms
Early signs and symptoms (3 to 30 days after tick bite)
- Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes may occur in the absence of rash
- Erythema migrans (EM) rash (see photos):
- Occurs in approximately 70 to 80 percent of infected people
- Begins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days)
- Expands gradually over several days reaching up to 12 inches (30 cm) or more across
- May feel warm to the touch but is rarely itchy or painful
- Sometimes clears as it enlarges, resulting in a target or "bull's-eye" appearance
- May appear on any area of the body
- Does not always appear as a "classic bull's-eye" rash
- Occurs in approximately 70 to 80 percent of infected people
![Erythema migrans rashes on two different skin tones to show the wide variety of appearances.](/lyme/media/images/EM-rashes.jpg)
Later signs and symptoms (days to months after tick bite)
- Severe headaches and neck stiffness
- Additional EM rashes on other areas of the body
- Facial palsy (loss of muscle tone or droop on one or both sides of the face)
- Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
- Intermittent pain in tendons, muscles, joints, and bones
- Heart palpitations or an irregular heartbeat (Lyme carditis)
- Episodes of dizziness or shortness of breath
- Inflammation of the brain and spinal cord
- Nerve pain
- Shooting pains, numbness, or tingling in the hands or feet
![Later signs and symptoms of Lyme disease include swollen knees, irregular heartbeat, and facial palsy.](/lyme/media/images/Later-signs-and-symptoms-of-LD.jpg)
Reminder
Seek medical attention if you observe any of these symptoms and have had a recent tick bite, live in an area known for Lyme disease, or have recently traveled to an area where Lyme disease occurs.
More about rashes
- A small bump or redness at the site of a tick bite that occurs immediately and resembles a mosquito bite, is common. This irritation generally goes away in 1-2 days and is not a sign of Lyme disease.
- A rash with a very similar appearance to EM occurs with Southern Tick-associated Rash Illness (STARI) but is not Lyme disease.
- Ticks can spread other organisms that may cause a different type of rash.