The Concept of Pathological Patterns of the Body in Contacts With the External Environment: Principles of Analysis of Early and Later Skin and Mucosal Lesions in Connection With Covid-19 and Co-Infections

The goal is to develop a conceptual understanding of pathological patterns (PPs) in relation to the COVID-19 pandemic, waves, and outbreaks. The concept of PPs is based on observations of PPs in elderly patients aged 65+ (2020-November 2025) in relation to COVID-19, acute respiratory viral infections, and acute respiratory infections. It is supported by our own publications on PPs in macro-systems of the body that are in contact with the external environment (using the examples of the skin and mucosal envelopes). The main provisions of the concept, and the principles of PP analysis are outlined. A personalized analysis of PP patients with signs of COVID-19 (lung damage, erythema and skin rashes, mucosal disorders in the absence or low titers of anti-COVID-19 antibodies), including those vaccinated and revaccinated against COVID-19, was conducted in connection with the pandemic and subsequent waves and outbreaks of COVID-19. The results indicate the high sensitivity of the body's macro-systems. Early and later short-term manifestations on the skin and mucosa of PP erythemas, rashes, and other types of lesions in connection with the COVID-19 pandemic and further seasonal manifestations of post-COVID syndrome and long COVID-19 have been established. Cascade chains have been identified that combine primary and secondary PPs in connection with the seasonality of COVID-19, including those that reflect changes in the circulatory system. Against the background of the similarity of the primary PPs in patients, the secondary PPs were characterized by an increase in the diversity of differences between patients, which could be represented as a personalized unique tree of the patient's pathologies. The contribution of the patient's existing pathologies (including chronic ones) to the formation of such a tree was noted. The branching of the tree during periods of long COVID-19 reflected the combined nature of the resulting PPs under the influence of acute respiratory viral infections and acute respiratory diseases. Based on a generalized analysis of the PPs of patients' macro-systems in contact with the external environment during periods of pandemic and later outbreaks of COVID-19, a concept of PPs has been proposed. The key terms of the concept have been described. The diagnostic and prognostic significance of the concept, as well as its connection to infection, have been assessed. The prognostic value of the concept lies in its ability to predict the development of characteristic early and later personalized PPs in relation to post-COVID-19. A classification of the PP topography has been provided. The concept allows for the development of therapeutic vectors in PPs and strategies for accelerated elimination of PPs. The data and approaches presented in this article will help in the diagnosis, prognosis, prevention, and treatment of post-viral syndrome in connection with viral infections.