Malva sylvestris

Malva sylvestris (Common Mallow)

1. Identity, Taxonomy, and Natural Source

Malva sylvestris L. is a member of the class Equisetopsida, subclass Magnoliidae, superorder Rosanae, order Malvales, family Malvaceae, and genus Malva. Known in English as common mallow, the plant is native to Europe, North Africa, and Asia. It is a biennial-perennial herbaceous plant commonly found in North Africa, Europe, and Southwest Asia.

Details of its botanical descriptions can be found in official references such as the Brazilian, Helvetic, British, and European Pharmacopoeias. The flowers of M. sylvestris are almost odourless and have a mucilaginous taste when chewed. The plant's accepted binomial scientific name is Malva sylvestris L., where "L." denotes the Linnaean authority. The herbal drug materials derived from the plant are formally designated Malvae folium (mallow leaf) and Malvae sylvestris flos (mallow flower) in the European Pharmacopoeia.

In Iran, M. sylvestris is commonly used as a vegetable and medicinal plant, where it is named "Panirak." Young leaves, shoots, flowers, and fruits are consumed in salads, soups, or as boiled root vegetables. The leaves, flowers, and roots are used for medicinal reasons.

Common Forms and Preparations

Roots, shoots, leaves, flowers, fruits, and seeds are applied in infusions, decoctions, poultices, liniments, lotions, baths, and gargles. Besides use in inflammation of the mouth and throat when applied in a form of infusions, decoctions as a herbal tea or a gargle, cutaneous use for treatment of cuts, infected wounds, and skin burns in a form of poultices and lotions is described in the literature. Official EMA-recognized preparations include comminuted herbal substance as herbal tea for oral use and comminuted herbal substance for infusion or decoction preparation. Fluid extracts, syrups, creams, and standardized dry extracts are also commercially available. Commercial tea products are among the primary dosage forms of mallow.

2. Traditional and Historical Use

Among the numerous species used in folk medicine, Malva sylvestris L. (Malvaceae) stands out due to its variety of uses, with its consumption reported to have originated in approximately 3000 BCE. Archaeological studies in the region of Syria have shown the existence of M. sylvestris seeds in dental calculus from human fossils, leading to the conclusion that the consumption of this species is longstanding, due both to it being an edible plant and to its possible medicinal properties.

There is evidence of the use of Malva sylvestris for the past thousand years in Europe. Remains of Malva sylvestris, together with remains of other medicinal plants, have been found through archaeological research among the oldest Central European inhabitants — living in Lower Saxony more than 6,000 years ago.

In ancient times, the plant was used by the Greeks and Romans for its emollient and laxative properties. The Greeks and Romans claimed its emollient and laxative properties, and several ethnobotanical surveys conducted in Europe highlight the potential of this neglected local resource. In the Mediterranean region, this species has a long history of use as food, and due to its therapeutic relevance, some parts of this plant have been employed in traditional and ethnoveterinary medicines.

In current folk medical practice in Italy, Malva sylvestris is widely used; decoctions of the leaves are used locally in inflammation of the mouth in the region of the northern Italian Ligurian Alps. In Lombardy, widespread use of both Malva sylvestris and Malva neglecta Wallr. was recorded as anti-inflammatory, laxative, and emollient decoction on wounds and sores. In central Italy, decoctions of aerial parts are used as a laxative and topically applied to the cheek or directly into aching teeth.

Traditionally, M. sylvestris has been used for inflammation, gastrointestinal disturbances, skin disorders, menstrual pains, and urological disorders. The plant flowers are used as a remedy for cut wounds, eczema, dermal infected wounds, bronchitis, digestive problems, and inflammations in Iranian folk medicine. A decoction made from the plant's aerial parts is commonly utilized in traditional Persian medicine for treating gastrointestinal lesions, as a tonic for the gastrointestinal system, or even as a side dish.

Mallow is traditionally used, due to its high mucilage content, for treatment of the symptoms of oral or pharyngeal irritations, associated dry cough, and gastrointestinal discomfort. There is also a long history of using flowers as a food ingredient and adjuvant in the Orient. Experts have revealed that Malva sylvestris has been used in traditional medicine for emollient and laxative functions since the dawn of time, and in popular treatment for its anti-inflammatory effects.

3. Key Constituents and Active Compounds

Phytochemical analysis of Malva sylvestris revealed that the leaves and flowers are the most commonly used parts of the plant and contain various bioactive compounds such as flavonoids, mucilages, terpenoids, phenol derivatives, coumarins, sterols, tannins, saponins, and alkaloids.

Mucilages (Polysaccharides)

The order Malvales has the highest content of mucilages among the dicotyledonous plants. This is notably true for the family Malvaceae, particularly the species Malva sylvestris, where the occurrence of polysaccharides has been known for decades. Malvales are the order of dicotyledonous plants with the most mucilage, and studies carried out for more than 50 years have revealed the presence of polysaccharides in the family Malvaceae. The mucilages contain trehalose, galactose, sucrose, glucose, fructose, mannose, rhamnose, galacturonic, and glucuronic acid, but also 2″-O-α-(4-O-methyl-α-d-glucuronosyl)-xylotriose, raffinose, fucose, xylose, arabinose, and uronic acid.

Flavonoids and Anthocyanins

Flavonoids, particularly anthocyanins such as malvin (malvidin 3,5-glucoside, found only in the flavylium cationic form), have been identified mostly in flowers. Other identified compounds include oenin (malvidin 3-O-glucoside), malvidin, delphinidin, delphinidin-3-O-glucoside, kaempferol derivatives, quercetin, apigenin, myricetin, and genistein. The total anthocyanin content was found to be 0.42 to 7.3% of dry weight. Leucoanthocyanins, cyanidin, and petunidin have also been discovered, albeit only in trace amounts.

HPLC analysis of M. sylvestris methanolic extract has allowed the identification of apigenin, quercetin, kaempferol, genistein, myricetin, and 5,7-dimethoxycoumarin. The leaves are the richest in flavonoids, and this explains their therapeutic properties in traditional medicine.

Phenolic Compounds and Vitamins

Malva extract contains different compounds including phenolic derivatives, flavonoids, terpenoids, catalase enzymes, sulfite oxidase, fatty acids, and certain sterols (specifically essential fatty acids such as omega-3 and omega-6), beta-carotene, and vitamins C and E, which have anti-inflammatory and antioxidant properties. Ascorbic acid (vitamin C) and tocopherols (vitamin E) are responsible for the antioxidant effect of M. sylvestris, whereas phenolics may also be responsible for antioxidant and free-radical scavenging activities.

Terpenoids

The chemical composition of a water extract of M. sylvestris has been investigated by HPLC, NMR, and MS analysis and resulted in the isolation of a sesquiterpene and a new tetrahydroxylated linear diterpene, as well as two monoterpenes: linalool and linalool-1-oxide. Reports have revealed the presence of malvone A (a naphthoquinone) and different known monoterpenes, aromatic compounds, and a tetrahydroxylated acyclic diterpene.

Naphthoquinones

Malvone A, a naphthoquinone, has been isolated from M. sylvestris stems. Malvone A was also discovered to be a phytoalexin triggered by various plant disease microorganisms, and this chemical may be responsible for M. sylvestris's excellent antibacterial action against various plant and human disease microbes.

Sterols

In M. sylvestris leaves, the presence of stigmasterol, γ-sitosterol, and the steroid campesterol has been reported.

Full Phytochemical Profile Summary

The plant contains tannins; vitamins A, C, and E; folic acid; niacin; polyphenols (anthocyanins); scopoletin; malvone A (2-methyl-3-methoxy-5,6-dihydroxy-1,4-naphthoquinone); malvaline; malvidin 3-(6″-malonyl-glucoside)-5-glucoside; malvin; flavonoids (including three 8-hydroxyflavonoids, hypolaetin 3′-sulphate, and gossypetin 3-sulphate-8-O-β-d-glucoside); polysaccharides (mucilage); and coumarins.

4. Established Mechanisms of Action

Demulcent / Emollient Effects (Mucilage)

Fluid extracts of M. sylvestris leaves and flowers are used to treat inflammatory diseases of mucous membranes, cystitis, and diarrhea. This plant derives its restorative competencies from the mucilage and flavonoids located in the flowers and leaves. The high-molecular-weight polysaccharides in the mucilage form a protective coating on irritated mucosal surfaces, acting as a mechanical barrier against irritants and reducing friction in the respiratory and gastrointestinal tracts.

Anti-inflammatory Mechanisms

The aqueous fraction of M. sylvestris extract was identified as the bioactive fraction in both in vitro and in vivo assays; it controlled neutrophil migration to the peritoneal cavity by 66%, inhibited antiedematogenic activity by 58.8%, and controlled IL-1β cytokine expression by 54% in animal models. The chloroform fraction was the most effective in reducing bacterial colonization and controlling inflammatory mediators, promoting the down-regulation of genes including IL-1beta, IL-6, IL-10, CD14, PTGS, MMP-1, and FOS, as well as reduction of IL-1beta, IL-6, IL-8, and GM-CSF protein levels in oral human cells.

Antioxidant Activity

The antioxidant properties of Malva sylvestris were confirmed by two separate methods: the diphenyl-2-picrylhydrazyl (DPPH) assay and the nitroblue tetrazolium reduction assay. Methanolic extracts of flowers and leaves were evaluated by several different assays and models, including diphenyl-2-picrylhydrazyl radical absorption, neutralization of linoleate free radicals, and beta-carotene models; all parts of this plant were shown to have antioxidant activity.

Laxative Mechanisms

Proposed mechanisms for M. sylvestris efficacy in constipation include mucilage's osmotic laxative properties and possible gut microflora modulation via fermentation of monosaccharides. Additionally, acetylcholinesterase inhibition may enhance gut motility, further impacting constipation symptoms.

Antimicrobial Activity

The antimicrobial activities of the plant are attributed to the presence of various antimicrobial compounds; naphthoquinones, anthocyanidins, flavonoids, or mucilaginous polysaccharides that are present in high amounts are among the most significant compounds with antimicrobial properties. Malvone A in M. sylvestris flower extract may be responsible for antibacterial activity.

5. Scientific Evidence by Area of Use

5.1 Oral and Pharyngeal Irritation / Dry Cough

The European Medicines Agency's Committee on Herbal Medicinal Products (HMPC) conclusions on the use of mallow flower medicines for mouth or throat irritation and associated dry cough are based on their "traditional use." This means that, although there is insufficient evidence from clinical trials, the effectiveness of these herbal medicines is plausible and there is evidence that they have been used safely in this way for at least 30 years (including at least 15 years within the EU). In its assessment, the HMPC considered laboratory studies showing cough reduction and anti-inflammatory effects of mallow flower preparations, but noted the lack of studies with mallow flower in patients.

Evidence strength: Traditional use classification by a major regulatory body (EMA/HMPC). No randomized clinical trials in human patients for this specific indication were identified by the HMPC at the time of its assessment. Plausibility is supported by in vitro and mechanistic data on mucilage coating and anti-inflammatory constituents.

5.2 Gastrointestinal Discomfort and Constipation

The HMPC concluded that, on the basis of its long-standing use, mallow leaf preparation can be used to treat irritation of the mouth or throat and associated dry cough, and to relieve mild discomfort of the stomach and gut.

A placebo-controlled clinical trial by Elsagh et al. (2015), published in Complementary Therapies in Clinical Practice, is among the few human studies specifically testing constipation outcomes. Adults with functional constipation were allocated to receive M. sylvestris L. flowers aqueous extract syrup (1 g extract/day) or placebo for four weeks; frequency of constipation symptoms and stool forms were assessed every week. The study concluded that the M. sylvestris L. flowers aqueous extract is efficacious and safe for the treatment of functional constipation in adult patients, and that investigating the mechanisms of action is warranted.

Extracts of some Malva species have also been shown to protect rats from gastric lesions induced by ethanol; this antiulcerogenic activity may be associated with the high mucilage content from the plant species. An anti-ulcerogenic effect was demonstrated in an animal study, showing that the aqueous extract was more effective than cimetidine, a potent medicine used to treat gastric ulcers.

Evidence strength: One placebo-controlled human clinical trial supports the laxative/constipation indication. The antiulcer effect is supported by animal (in vivo) studies only. The EMA/HMPC has granted traditional-use status for gastrointestinal discomfort.

5.3 Anti-inflammatory Activity

Given their medical importance, natural products represent a source of drug discovery; investigation of Malva sylvestris L. extract and fractions demonstrated that the aqueous fraction (AF) was identified as the bioactive fraction in both in vitro and in vivo assays. In animal models, M. sylvestris has shown antinociceptive, anti-inflammatory, and anti-carrageenan-induced paw oedema activity when locally administered.

An in vitro study found that Malva sylvestris and its chloroform fraction were able to minimize the infection and inflammation process in oral human cells by a putative pathway that may involve antimicrobial effect and modulation of cytokines and receptors. This was conducted using an in vitro oral human cell infection model, not a clinical trial.

Evidence strength: Predominantly in vitro and animal studies. One in vitro human cell model exists. No large controlled human clinical trials specifically assessing anti-inflammatory endpoints have been published.

5.4 Wound Healing

Malva sylvestris flowers have a high mucilage content and are used as a remedy for cut wounds and dermal infected wounds in Iranian folklore medicine. A study investigated the effect of M. sylvestris cream on second-degree burn injury in rats. Five groups of 10 rats per group were burned with a hot metal plate and administered normal saline, standard silver sulfadiazine 1% (SSD), 5% M. sylvestris, or 10% M. sylvestris preparations. In most cases, 10% M. sylvestris cream showed a better healing effect than other groups. Wound sizes were not significantly different among groups on the 1st and 3rd days after burn injury, while they were significantly different among groups after the 7th day post-burn injury.

A separate study evaluated the effects of Malva sylvestris aqueous extract on cutaneous wound healing in BALB/c mice. Twenty-seven male BALB/c mice were used; a cut wound (superficial fascia depth) was made locally, and mice were divided into groups receiving topical administration of 1% M. sylvestris aqueous extract, silver sulfadiazine topical cream, or cold cream. On days 4, 7, and 10, excisional biopsies were performed and wound healing was evaluated histopathologically. On days 4 and 7, the numbers of inflammatory cells in the silver sulfadiazine and M. sylvestris-treated groups were significantly lower than in the control group, and keratinization at the edges of the wound in both groups was significantly higher than the control group.

However, a human randomized controlled trial specifically examining wound healing found a different result. A double-blinded randomized-controlled clinical trial aimed to pursue the effect of Malva sylvestris cream on episiotomy pain and healing; sixty women were selected and randomly assigned to control and intervention groups using block randomization. No significant statistical differences were found between the two groups in terms of perineal healing or pain scores; however, the chance of external dysuria in the intervention group decreased by 77%. Despite showing a positive effect on wound healing in animal and in vitro studies, this clinical study failed to show the positive effect of the extract on wound healing and pain relief of episiotomy. Future clinical trials are needed to substantiate these findings.

Evidence strength: Animal studies (rodents) support wound-healing activity. The single human RCT (episiotomy) did not replicate these effects, demonstrating the gap between preclinical findings and clinical outcomes. Evidence in humans is currently insufficient.

5.5 Antimicrobial Activity

A study revealed the antimicrobial effect of anthocyanin extracted from M. sylvestris. Anthocyanin showed promising antimicrobial activity against S. aureus but had no cytotoxic activity against Aspergillus niger and E. coli. With increasing anthocyanin content, bacteriostatic activity was increased. Minimum inhibitory concentrations of M. sylvestris extract (MIC 175 μg/mL, MBC 500 μg/mL) and chloroform fraction (MIC 150 μg/mL, MBC 250 μg/mL) were found to have inhibitory activity in laboratory testing.

Evidence strength: All antimicrobial evidence is from in vitro studies. No human clinical trials on infectious endpoints exist.

5.6 Antinociceptive (Pain-Relieving) Activity

Broad antinociceptive activity was demonstrated in the writhing test (76.4% inhibition), as well as inhibition of the inflammatory (46.6%) and neurogenic (61.8%) phases of the formalin model. The results suggest that mallow sylvestris possesses stimulatory substances that act as antinociceptive agents. These findings derive from animal models, not human trials.

Evidence strength: Animal/in vivo studies only. No human clinical data available for pain relief as an independent indication.

5.7 Anticancer / Antiproliferative Activity

M. sylvestris showed antineoplastic activity in B16 cells, provided by flavonoids: quercetin, apigenin, genistein, and myricetin. Coumarins from mallow have demonstrated potential anticancer activity. Research has presented an overview of cytotoxic effects of Malva sylvestris on different types of cancer cells.

Evidence strength: All anticancer evidence is limited to in vitro cell-line studies. No animal in vivo oncology studies or any human clinical trials exist for this indication. The in vitro findings cannot be directly extrapolated to clinical outcomes.

5.8 Hepatoprotective Activity

Extensive research shows that M. sylvestris, with its different chemical compounds, can minimize liver damage caused by carbon tetrachloride in experimental models. Extract of Malva sylvestris significantly reduced serum levels of elevated liver enzyme markers in a dose-dependent manner in experimental studies.

The protective effect of the common mallow (Malva sylvestris) decoction on renal damage in rats induced by ammonium metavanadate poisoning was evaluated. These antioxidant properties were confirmed in Malva sylvestris by two separate methods: the diphenyl-2-picrylhydrazyl assay and the nitroblue tetrazolium reduction assay.

Evidence strength: Animal (in vivo) studies in rodents only. No human clinical trials on hepatoprotective outcomes exist.

5.9 Antilipidemic / Cardiovascular-Associated Effects

Anthocyanins from M. sylvestris caused decreases in total cholesterol and triglycerides of plasma in rat studies. One study in rats investigated the effects of anthocyanin from M. sylvestris on plasma lipids; decreases in total cholesterol (20%) and triglycerides (34%) were found.

Evidence strength: Animal studies only. No human clinical data exist for lipid-lowering effects.

5.10 Skin and Cosmetic Applications

The extract from M. sylvestris L. was evaluated for its anti-aging efficacy through regulation of genes at the transcription level. The results suggest that M. sylvestris L. extract modulated some genes in the same way as all-trans retinoic acid, a well-established therapeutic agent for photodamage and wrinkles. The leaves, in particular, offer properties like anticancer, skin whitening, and anti-aging effects in experimental models.

The Cosmetic Ingredient Review (CIR) Panel concluded that the safety of Malva sylvestris-derived cosmetic ingredients was supported by data on confirmed food use, which mitigated systemic toxicity concerns, and negative findings in human dermal irritation and sensitization studies on the Malva Sylvestris Flower/Leaf/Stem Extract and Malva Sylvestris Flower Extract. The Panel noted the presence of constituents (e.g., cinnamal) which are possible sensitizers, though at levels below concern for these individual ingredients, and concluded that these 8 ingredients are safe in cosmetics in the present practices of use and concentration when formulated to be non-sensitizing.

6. Body Systems and Health Areas

• Respiratory system: Leaves and flowers have been used for centuries in traditional medicine to treat various ailments such as cough and cold.
• Gastrointestinal system: The leaves and flowers contain various bioactive compounds responsible for pharmacological activities including laxative and anti-inflammatory properties. Traditional and one clinical trial supports use in functional constipation; animal and traditional use data support antiulcer effects.
• Oral mucosa / oropharynx: Mallow is traditionally used for treatment of the symptoms of oral or pharyngeal irritations and associated dry cough.
• Skin / integumentary system: The flowers have a high mucilage content and are used as a remedy for cut wounds and dermal infected wounds in Iranian folklore medicine.
• Renal / urinary system: The plant can protect the kidney against injuries due to renal toxicity resulting from the cisplatin and vanadium system, based on animal model evidence.
• Immune and inflammatory pathways: Malva sylvestris and its chloroform fraction were able to minimize the infection and inflammation process in oral human cells, suggesting potential as a dual anti-inflammatory–antimicrobial candidate.
• Hepatic system: Animal evidence supports protective activity against experimentally induced liver damage.

7. Dosage Forms and Reported Dosages

The following dosages are reported in specific sources; they do not represent universal recommendations.

• A placebo-controlled clinical trial administered M. sylvestris L. flowers aqueous extract syrup at 1 g extract/day for four weeks for functional constipation.
• A historical pharmacopoeial reference documents a traditional daily dose of 5 g of dried leaf material.
• A topical cream formulation was applied twice a day for up to 14 days in the episiotomy wound-healing RCT.
• In a rodent wound-healing experiment, topical administration of a 1% aqueous extract of M. sylvestris was used.
• In an animal burn-injury model, preparations of 5% and 10% M. sylvestris cream were compared against silver sulfadiazine 1% control.
• In rat toxicological studies, doses of 400 and 800 mg/kg body weight were administered as aqueous extract from plant shoots.
• Official EMA-recognized oral dosage forms include comminuted herbal substance as herbal tea and comminuted herbal substance for infusion or decoction preparation.

8. Safety Considerations and Notable Interactions

General Safety Profile

At the time of the HMPC assessment, no side effects had been reported with these medicines. Malva sylvestris has been shown to be safe when used in traditional medicine to treat various ailments such as cough, cold, diarrhoea, and constipation. Literature data indicate that M. sylvestris is safe at low concentrations, although further research is required to evaluate potential negative consequences associated with its high dosages and prolonged consumption.

Gaps in Toxicological Data

Despite the widespread use of M. sylvestris as a food or herbal medicine, only one formal toxicity test had been performed as of a 2012 review. In that case, the Microtox Acute Toxicity assay showed that the hydroalcoholic extract had toxicity very close to the established maximum (20% of bioluminescence inhibition). Thus, further studies should be performed to assess the toxicity of M. sylvestris extracts.

More clinical studies are needed to assess the plant's safety and efficacy in treating various conditions. Further research is also necessary to determine whether there are any toxicological consequences to consuming large doses of Malva sylvestris extracts or nanoparticles over a long period.

Lipid Interactions at High Doses

When doses of 400 and 800 mg/kg body weight of aqueous extract were administered to rats, only serum triglycerides increased significantly, while the glycaemic, liver enzymatic, and lipid profiles were not affected. This result disagreed with other studies that demonstrated reductions of triglyceride and uric acid levels.

Possible Sensitizers

The CIR Panel noted the presence of constituents (e.g., cinnamal) which are possible sensitizers, though at levels below concern for these individual ingredients when used in cosmetics.

Pregnancy and Lactation

There is no clinical evidence to support the safe use of the herb during pregnancy and lactation.

Drug Interactions

No well-documented drug interactions have been identified in the published literature. However, the mucilage content of M. sylvestris could theoretically delay or reduce the absorption of co-administered oral medications; this mechanism is consistent with the known behavior of other high-mucilage herbal products, though it has not been formally studied for M. sylvestris.

Evidence Assessment Summary

Research has provided evidence that M. sylvestris has potential use as a medicinal plant and has highlighted a need for more studies involving clinical and toxicological aspects of its use. In general, Malva spp. have rather moderate antimicrobial activity, high anti-inflammatory and wound-healing activities, strong antioxidant activity, and anticancer properties; results from in vitro and in vivo experiments encourage more in-depth studies, namely clinical trials, to improve knowledge on the use of Malva spp. for the treatment of various health conditions in humans.

References

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