This spelling of the classic name is found in France, Germany, Greece, and other cultures, and is worn by such notables as Elisabeth Kubler-Ross, Elisabeth Shue, Elisabeth Moss, and Elisabeth Hasselbeck. The name's pronunciation is usually just like the Z version, but some parents choose this because they want to discourage the Liz or Lizzie short forms and so pronounce it as if it has Lisa in the middle.

Elisabeth is nicknamed Bethsy in the 2008 film adaptation of Thomas Mann's Buddenbrooks, Bep in The Diary of Anne Frank, and Betsy in the Wolverine universe.

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