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

Recent literature has highlighted an association between severe atopic dermatitis (AD) in infancy and biochemical disturbances consistent with secondary hyperaldosteronism. Transepidermal sodium loss driving volume depletion has been hypothesized to contribute to this process, but direct evidence of the underlying mechanisms remains sparse. We present a case series of 3 children, aged 3 to 7 months, who were admitted with severe exudative eczema associated with hyponatremia and hyperkalemia, despite evidence of effective renin-angiotensin-aldosterone system activation and renal mineralocorticoid action. In each case, these biochemical and hormonal disturbances resolved after optimizing dermatological and nutritional management of their atopic presentations, supporting the role of extrarenal mechanisms of electrolyte disturbance. Our case series highlights the importance of considering biochemical and hormonal factors in the comprehensive early treatment of infantile AD to prevent complications associated with electrolyte imbalances and nutritional deficiencies.