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Introduction Morphea remains underrecognized in international cohorts, with limited data from the Middle East. This study reports the largest multicenter cohort from the Gulf region, including cohorts from the United Arab Emirates, Saudi Arabia, and Qatar, characterizing epidemiology, clinical features, and treatment trends of morphea.Material and Methods We retrospectively analyzed 127 patients with morphea across multiple tertiary centers in the Gulf region. Demographic, clinical, serologic, histopathologic, and treatment data were extracted from electronic medical records. Descriptive statistics were used to summarize the data, and comparative analyses were performed with p-values reported where applicable. A p-value of <0.05 was considered statistically significant.Results Among 127 patients, 86.6% were Arab and 78.7% were female, with a mean age at diagnosis of 32.8 ± 16.2 years and a mean disease duration of 6.4 ± 5.7 years. Generalized morphea was observed in 25.2% of cases. The trunk and upper extremities were the most frequently affected sites (both 50.8%), while head and neck involvement occurred in 26.2%. The most common presenting features were skin hyperpigmentation (89.3%) and erythema (56.3%), with arthritic manifestations in 20.5% of patients. ANA positivity was observed in 28.3%, predominantly with homogeneous and speckled patterns. Skin biopsy was performed in 69.3% of cases. Systemic treatments included corticosteroids (39.1%) and methotrexate (27.6%), with adjunctive phototherapy used in 24.5% of patients. No malignancies were reported in this cohort.Conclusions This study represents the largest multicenter cohort of morphea from the Gulf region, highlighting a younger age at diagnosis, a high prevalence of generalized disease, and notable extracutaneous involvement. The findings underscore the importance of early recognition, comprehensive multidisciplinary management, and the need for prospective studies to better understand long-term outcomes and optimize treatment strategies in this population.Abstract P.220 Table 1Demographic data of patients with morphea from the multicenter cohortAbstract P.220 Table 2Clinical features of patients with morphea from the multicenter cohort