Sometimes at the site of a tick bite, a persistent firm papulonodular lesion may develop. A common site for this reaction to develop is in the scalp. This area may be very pruritic and with excoriation may result in secondary infection. Topical or intralesional corticosteroids may alleviate the pruritus and inflammation, but sometimes these nodules persist for many months and may require biopsy for confirmatory diagnosis and treatment.