Secondary hyperaldosteronism associated with severe infantile atopic dermatitis: a case series

Recent literature has highlighted an association between severe atopic dermatitis in infancy and biochemical disturbances consistent with secondary hyperaldosteronism. Trans-epidermal sodium loss driving volume depletion has been hypothesised to contribute to this process, but direct evidence of the underlying mechanisms remains sparse. We present a case series of three children, aged three to seven months, who were admitted with severe exudative eczema associated with hyponatraemia and hyperkalaemia, despite evidence of effective RAAS activation and renal mineralocorticoid action. In each case, these biochemical and hormonal disturbances resolved after optimising dermatological and nutritional management of their atopic presentations, supporting the role of extra-renal mechanisms of electrolyte disturbance. Our case series highlights the importance of considering biochemical and hormonal factors in comprehensive, early treatment of infantile atopic dermatitis to prevent complications associated with electrolyte imbalances and nutritional deficiencies.