Before forming Dead Or Alive, Burns was a member of the short-lived Mystery Girls, and then Nightmares in Wax, an early proto-goth, semi-punk group that formed in Liverpool around 1980. Nightmares in Wax put out a 12" single, "Black Leather," and a 7" single, "Birth of a Nation," each containing the same three songs, but never did an album. Burns has accused fellow pop star Boy George of copying his style and mainstreaming his unique image, although the pair have since buried the hatchet with Burns guesting on O'Dowd's radio show '...and another thing'.

Known for his blatant sexuality and flamboyant style, Burns shocked audiences in the 1980s with his pre-Boy George androgyny, exotic hairstyles and heavy make-up (although he maintains that he is not a transvestite, and that his wardrobe choices are based on fashion and image rather than sexual enjoyment). Almost as much as his career with Dead or Alive, Burns is known for his ever-changing appearance, which he freely admits has been greatly modified by plastic surgery.

Burns collaborated with Pet Shop Boys in 2004, resulting in the single 'Jack and Jill Party' which was released on PSB's own Olde English label. Although the single was an internet-only release, it managed to get into the lower reaches of the top 75.

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