Background: Tetrandrine, a bis-benzylisoquinoline alkaloid, induces apoptosis of many types of human cancer cell. Hydrogen peroxide (H 2 O 2 ) is a reactive oxygen species inducer; however, there are no reports to show whether pretreatment of tetrandrine with H 2 O 2 induces more cell apoptosis than H 2 O 2 alone. Thus, the present study investigated the effects of tetrandrine on H 2 O 2 -induced cell apoptosis of human keratinocytes, HaCaT, in vitro. Materials and Methods: HaCaT cells were pre-treated with and without tetrandrine for 1 h, and then treated with H 2 O 2 for examining cell morphological changes and cell viability using contrast-phase microscopy and propidium iodide (PI) exclusion assay, respectively. Cells were measured apoptotic cell death by using annexin V/PI double staining and further analyzed by flow cytometer. Cells were further assessed for DNA condensation using 2-(4-amidinophenyl)-6indolecarbamidine staining. Western blotting was used to measure expression of apoptosis-associated proteins and confocal laser microscopy was used to measure the protein expression and nuclear translocation from the cytoplasm to nuclei. Results: Pre-treatment of tetrandrine for 1 h and treatment with H 2 O 2 enhanced H 2 O 2 -induced cell morphological changes and reduced cell viability, whilst increasing apoptotic cell death and DNA condensation. Furthermore, tetrandrine significantly increased expression of reactive oxygen species-associated proteins such as superoxide dismutase (Cu/Zn) and superoxide dismutase (Mn) but significantly reduced the level of catalase, which was also confirmed by confocal laser microscopy. It also increased expression of DNA repair-associated proteins ataxia telangiectasia mutated, P53 and phosphorylated histone H2AX, and poly ADP ribose polymerase in HaCaT cells. Conclusion: These are the first and novel findings showing tetrandrine enhances H 2 O 2 -induced apoptotic cell death of HaCaT cells and may provide a potent approach for the treatment of proliferated malignant keratinocytes.