In art, lead white is known as flake white, also sometimes known as Cremnitz white. Flake white is traditionally considered to be the most structurally sound underpainting layer for oil painting, possessing a combination of flexibility, toughness, and permanence not found in other paints, and certainly not in the other white pigments. Genuine flake white is difficult for artists to obtain in many countries, even though other toxic paints (such as the cadmium-based colors) may be readily available. Where flake white is currently available to artists, it is usually only in small tubes designed for painting, not in the larger cans traditionally used for under paintings (coating the canvas prior to the actual painting) which for centuries was flake white's most important purpose.

Artists' use of lead paint is mostly associated with oil paintings on linen or cotton canvas. In the relatively rare cases where it has been used in works on paper, it will often become discolored over long periods of time. This is due to the reaction of the lead carbonate in the paint with traces of hydrogen sulfide in the air and with acids, often from fingerprints.  As a result, many older works on paper that used lead paint now show some discoloration.