The Canadian Morphea Registry: Design, Baseline Characteristics, and Age-Related Differences in a National Multicenter Cohort

Morphea is a rare immune-mediated fibrosing skin disorder with heterogeneous clinical manifestations across the lifespan. Existing large cohorts have predominantly originated from the United States and Europe, while national Canadian data spanning pediatric and adult disease are lacking.

To characterize morphea across the lifespan in a national Canadian cohort, with particular emphasis on age-related differences in clinical phenotype, diagnostic pathways, disease burden, and treatment patterns.

The Canadian Morphea Registry (C-MORE) is an ongoing prospective, multicenter observational registry of pediatric and adult patients with morphea and eosinophilic fasciitis. Baseline demographic, clinical, treatment, and patient-reported outcome data accrued from June 2021 through August 2025 were analyzed and compared by age group and against established international registries.

Among 213 patients enrolled across 9 academic centers, 68.5% were adults; 31.5% were children. Linear morphea predominated in children (49.2%) and generalized morphea in adults (31.3%). The mean diagnostic delay was 1.9 years, and 27.2% reported prior misdiagnosis, most commonly eczema. Adults had higher baseline disease activity, whereas children carried greater cumulative damage, including among those classified as inactive. Systemic therapy was more common in children (61.0%) than adults (39.1%); methotrexate was most frequently prescribed.

C-MORE provides the first national Canadian characterization of pediatric and adult morphea within a publicly funded healthcare system. Marked age-related differences in phenotype, disease activity, accumulated damage, and treatment were observed, while diagnostic delay and frequent prior misdiagnosis remained important across age groups. Longitudinal follow-up will determine how these differences influence disease trajectories and treatment outcomes.