Objective We sought to examine – for the first time – the clinical manifestations of cutaneous (CLE) and systemic lupus erythematosus (SLE) among patients in Nicaragua as well as socioeconomic correlates and medical care of CLE and SLE can be made.

Methods Patients with CLE or SLE treated by the FLESNIC Foundation in Nicaragua from January 2004 to March 2018 were included in the cross-sectional study. A questionnaire was completed at entry. Adjusted logistic regression analyses were used.

Results Of the 646 patients, 89,8% have SLE. The higher the income (OR 1.39; 95% CI: 1.17–1.68), the more likely physician visits occur. If patients live rural (OR 0.74; 95% CI: 0.58–0.95) or below the poverty line (OR 0.56; 95% CI 0.38–0.81), physician visits are less frequent. Patients with high education are more likely to take hydroxychloroquine (OR 1.27; 95% CI: 1.01–1.60), coumarins (OR 2.43; 95% CI: 1.10–5.64), antidepressants (OR 1.99; 95% CI: 1.45–2.75), and anxiolytics (OR 1.57; 95% CI: 1.04–2.37). They are also more likely to use sunscreen (OR 1.39; 95% CI: 1.11–1.76). The odds of memory loss (OR 4.66; 95% CI=1.22–24.26) and disorientation (OR 10.6; 95% CI: 1.78–209.28) is increased in CLE patients living below the poverty line. Fatigue is more common in patients with academic education and SLE (OR 3.19; 95% CI: 1.26–10.78). Cutaneous complications increase the odds of depression (OR 1.94; 95% CI 1.31–2.88), disorientation (OR 1.75; 95% CI 1.23–2.50), psychosis (OR 1.99; 95% CI 1.25–3.18), fatigue (OR 1.68; 95% CI 1.07–2.66), and irreversible CNS damage (OR 3.72; 95% CI 2.44–5.79). Discoid exanthema increase the odds of memory loss (OR 1.64; 95% CI 1.12–2.40) and psychosis (OR 1.83; 95% CI 1.14–2.92). Malar rash is more frequently associated with memory loss (OR 1.78; 95% CI 1.26–2.52), depression (OR 1.72; 95% CI 1.16–2.56), and psychosis (OR 2.12; 95% CI 1.35–3.36).

Conclusion We can demonstrate that a higher socioeconomic position has an influence on medical care of SLE and CLE. Inverse correlations are shown between socioeconomic position and cutaneous manifestations. Cutaneous and psychiatric symptoms are related. However, an association between socioeconomic position and psychiatric symptoms is not demonstrated.

Acknowledgements We are grateful to Dr. Johana Patricia Blandón Argeñal (Fundacion of systemic lupus erythematosus in Nicaragua, FLESNIC, Department of Internal Medicine, UNAN, León) for her longterm dedication for patients with lupus and her shared experience. We thank all the patients who participated in the study. We also thank German Academy Exchange Service (DAAD) and Carl-Duisberg-Scholarship (Bayer Foundation) for funding.