The first sign of Lyme disease in 70-80% of patients is a red circular rash, called an erythema migrans, around the puncture mark made where the tick pierced the skin. This rash appears after a 3-30 day delay. The most common shape of the rash is an oval 2-3 inches in diameter that usually lasts about 4 weeks. The center of the rash occasionally will lighten resulting in a bull’s-eye appearance. The rash does not itch but may feel warm to the touch. Flu-like symptoms may also develop that often include aches, fever, fatigue, muscle pain, joint pain, and headache. Arthritis, cardiac disease, and neurologic disorders may develop if the disease is not properly or promptly treated. Sometimes these more serious symptoms develop without the individual ever having had a rash.