The northern region of Bihar has a rich tradition of domestic ritual painting called Madhubani painting, traditionally created by women. Every element in Madhubani painting has a deep rooted symbolism and mainly depicts nature and Hindu religious motifs. Mahalaxmi Karn has broken away from the traditional and she includes more unusual iconography such as portraits of everyday people and visual depictions of Hindi poems in her paintings. Many of her works have a strong feminist elements. Mahalakshmi works with her husband Shantanu Das on some of her works and both artists have been drawn to new, everyday themes—an interest which developed into a book illustration, collaborations with photographers to create mixed-media works, and painting large-scale murals.

Mahalakshmi has received the scholarship from the Ministry of Culture, India for retelling the Ramayana in Madhubani style in 2013 and has contributed in the making of a photo book based on the Ramayana by French photographer Vasantha Yoganathan. In 2016 she was jointly awarded the protegé artist (in Madhubani art) by Ojas Art at the Jaipur Literature Festival. She has participated in exhibitions at Ojas Art Gallery, Delhi and at ArtRage Gallery, Syracuse amongst others and was chosen to represent Madhubani art at the International Folk Art Market in Santa Fe, USA.