Systemic and biologic therapies have varying failure rates and survival times in treating psoriasis. We aim to describe the patterns of therapy failure in psoriasis patients. A retrospective (January 2009 to May 2018) analysis of 250 psoriasis patients seen at a psoriasis referral center, and 806 treatment courses of several systemic and biologic therapies, was conducted to determine failure rates and survival times for systemic and biologic therapies. Systemic therapies failed more often due to their adverse effects (16.4% vs 7.2%, p < .001). Biologics failed more often due to secondary failure (24.2% vs. 9.3%, p < .001). Biologics had a longer survival time (23.9 ± 22.2 vs. 12.6 ± 15.4 months, p < .001), even with early failures (≤6 months) removed (29.0 ± 22.5 vs. 21.1 ± 16.4 months, p = .014). Tertiary referral center, unreported causes of failure, sample size. Systemic therapies fail more often due to adverse effects while biologics fail more often due to loss of efficacy. Biologic therapies have longer survival times than systemic therapies.