Erythema migrans appears in roughly 70-80% of Lyme cases and not always with a clear bullseye, so absence of a rash does not rule out infection.
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Steps
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DO NOT use the bullseye rash as a pass/fail test for Lyme disease.
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The erythema migrans rash appears in about 70-80% of confirmed Lyme cases, and it is often a uniform expanding red patch rather than a classic ringed bullseye.
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That means roughly one in five to one in four Lyme cases never develop a visible rash at all, especially on darker skin where it can be harder to see.
04
Watch for any expanding rash, fever, fatigue, headache, or joint aches in the days to weeks after a known or possible tick exposure.
05
See a clinician early; treatment is most effective when started promptly.