Spiny keratoderma, also known as music box spine keratosis and palmoplantar filiform hyperkeratosis, is a rare form of punctate palmoplantar keratoderma characterized by pinpoint keratotic projections on the palms and soles.

Spiny keratoderma may be inherited or acquired. The hereditary form is inherited in an autosomal dominant manner with onset typically in childhood. Acquired spiny keratoderma usually manifests after age 50. It has been associated with various malignancies, including renal, pulmonary, and gastrointestinal carcinomas, as well as lymphoproliferative malignancies and melanoma. Other reported underlying disease associations have included polycystic kidney disease, chronic renal failure, type 4 hyperlipoproteinemia, and pulmonary tuberculosis. It has been suggested that acquired spiny keratoderma may predate the diagnosis of a malignancy and that heightened malignancy screening is needed after its diagnosis.

There does not appear to be a sex or racial predilection for spiny keratoderma.