There are no symptoms associated with the lesion itself,  although many and varied symptoms and signs may be associated with the underlying cause of immunosuppression. The lesion is a white patch, which almost exclusively occurs on the lateral surfaces of the tongue, although rarely it may occur on the buccal mucosa , soft palate , pharynx or esophagus .  The lesion may grow to involve the dorsal surface of the tongue. The texture is vertically corrugated ("hairy") or thickly furrowed and shaggy in appearance. 
In addition, a marked decrease or an absence of Langerhans cells occurs in hairy leukoplakia biopsy tissues.
[ 6 , 7 ] Langerhans cells are the antigen-presenting immune cells that are required for an immune system response to the viral infection and their deficiency may permit EBV to persistently replicate and escape immune recognition.