Human epidermal keratinocytes possess cholinergic enzymes, which synthesize and degrade acetylcholine, and express both nicotinic and muscarinic classes of cholinergic receptors on their cell surfaces. These receptors bind acetylcholine and initiate cellular response. The presence in keratinocytes of a functional cholinergic system suggests a role for acetylcholine in most, if not all, aspects of keratinocyte function. Autocrine and paracrine acetylcholine are required to sustain the viability of keratinocytes in vitro, and cholinergic drugs can alter keratinocyte proliferation, adhesion, migration, and differentiation. Acetylcholine employs calcium as a mediator for its effects on keratinocytes. In turn, changes in calcium concentration may affect expression and function of keratinocyte cholinergic enzymes and cholinergic receptors. At different stages of their differentiation, keratinocytes may demonstrate unique combinations of cholinergic enzymes and cholinergic receptor types. This would allow basal, prickle, and granular keratinocytes to respond to acetylcholine differently, in accordance with their functions at each stage of keratinocyte development in epidermis.