Abstract: 【Abstract】 Objective To measure the skin thickness in patients with erysipelas by high-frequency ultrasonography （HF-USG）, and to compare the clinical efficacy of systemic antibiotics alone versus their combination with glucocorticoids in the treatment of erysipelas. Methods Hospitalized patients with erysipelas were enrolled from Zhongda Hospital, Southeast University from January to December in 2021, and randomly divided into the study group and control group according to the order of visits. The study group was treated with systemic cefathiamidine for 7 days followed by oral methylprednisolone at a dose of 0.4 mg·kg-1·d-1, while the control group was treated with cefathiamidine alone. Before and after the treatment for 10 days, the thickness of the epidermis-dermis layers and subcutaneous tissues was measured by HF-USG at the sites of the most severe skin lesions on the affected limbs and at the corresponding sites on the healthy limbs, and white blood cell （WBC） counts, neutrophil （NEU） counts, as well as C-reaction protein （CRP） levels were determined. The t test and non-parametric test were used to compare the efficacy between two groups. Results A total of 23 patients with erysipelas were enrolled. Among the 12 patients in the study group, 8 were males and 4 were females, and their age was 71.4 ± 11.4 years. Among the 11 patients in the control group, 7 were males and 4 were females, and their age was 67.4 ± 11.1 years. Before treatment, the thickness of the epidermis-dermis layers （0.33 ± 0.12 cm） and subcutaneous tissues （1.08 ± 0.49 cm） in the study group was not significantly different from that in the control group （0.25 ± 0.09 cm, 0.98 ± 0.46 cm; t = -1.83, -0.49, P = 0.081, 0.626, respectively）. After the 10-day treatment, the thickness of the epidermis-dermis layers and subcutaneous tissues of the skin lesions on the affected limbs significantly decreased in both groups compared with that before treatment （both P < 0.05）, and the decrease in the thickness of subcutaneous tissues was significantly stronger in the study group （0.32 ± 0.33 cm） than in the control group （0.10 ± 0.07 cm; t = 2.20, P = 0.039）. Before treatment, the WBC counts （［11.16 ± 4.42］ × 109/L）, NEU counts （［8.26 ± 4.16］ × 109/L） and CRP levels （median ［Q1, Q3］: 72.20 ［19.28, 140.50］ mg/L） in the study group were not significantly different from those in the control group （［10.10 ± 4.53］ × 109/L, ［7.21 ± 3.00］ × 109/L, 34.40 ［8.00, 74.20］ mg/L, respectively; t or Z = 0.60, 0.71, -0.85, P = 0.578, 0.496, 0.196, respectively）. After the 10-day treatment, the WBC counts, NEU counts, and CRP levels significantly decreased in both groups compared with those before treatment （all P < 0.05）. Conclusion The combined treatment with systemic antibiotics and glucocorticoids could effectively alleviate skin inflammation, and more rapidly reduce the thickness of inflamed subcutaneous tissues in patients with erysipelas compared with systemic antibiotics alone.

Key words: Erysipelas, Anti-bacterial agents, Glucocorticoids, Drug therapy, combination, Skin high-frequency ultrasonography