To investigate the association between lead powder use, as folk skin care, and blood lead level (BLL) in children, we studied 222 children up to 14-years old living in a Chinese rural area and administered a face to face interview with their parents to collect information on lead powder use and other potential exposure. We measured children's BLL at baseline and 2 years later after an intervention. The children were divided into three categories according to their use of lead powder: regular use, irregular use and never use. We applied multivariate linear regression to determine the association between lead powder use and elevated BLL. The average BLL of all children was 18 μg/dl; 56% of them had BLL of 10 μg/dl or higher. Lead powder use was significantly associated with elevated BLL. After adjusting for potential confounders the BLL of regular and irregular users was higher than non-users by 3.11 μg/dl and 1.47 μg/dl, respectively. Duration of lead powder use was positively associated with BLL, but the time since last use was inversely associated. A significant BLL reduction was observed 2 years later, and the greatest reduction (21 μg/dl) was seen in the youngest group of regular users. This study showed that traditional use of lead powder for a skin care purpose was a major contributor to elevated BLL in these children.