Background: Hand eczema is one of the most common dermatologic diseases requiring treatment but common therapeutics such as corticosteroids and anti-histamines have numerous side effects. So, use of herbal agents, which generally have no major side effects, may be useful especially if their efficacy is established. Malva Sylvestris (MS) is a tropical plant in Iran with cooling characteristics. Hence, in this study, its efficacy in of the treatment of hand eczema was evaluated. Methods: In this randomized clinical trial, 50 patients with hand eczema who were visited at Shohada-e Tajrish and Loghman hospitals, Tehran, Iran, between 2006 and 2008, were recruited and divided into two groups. In the first group, MS 4% ointment was applied twice a day and in the other group, placebo ointment was usd. The efficacy and side effects were evaluated three and six weeks after beginning of the treatment. Results: Mean age of the patients was 37.3 years and 35.6 years in MS and placebo groups, respectively (P > 0.05). There were no therapeutic adverse effects in the groups. There was a statistically significant difference in all measured scores between two groups in the first and second follow-up sessions (P < 0.0001). Conclusion: Malva Sylvestris seems to be a safe and effective therapeutic modality for the treatment of hand eczema and can be used as an optimal substitute for corticosteroids and antihistamines.