It is rare to 'see" a nutritional deficiency on paper. But horses don’t all metabolize nutrients the same way, with the same efficiency. The darker the horse’s coat color, the more copper and zinc are needed to maintain it, so IME, often a skin crud issue comes with “extra” fading/bleaching of the coat too.
I absolutely think it’s worth adding copper and zinc to that horse’s diet.
You MUST keep that area shaved with a #5 blade. Shave to just above the fetlock. Pick off scabs dab dry with a clean cloth, apply Desitin daily especially before any turnout. If your horse is out more than 5 hours he needs to be dried off again and reapply Desitin. This is the only thing that works. I live in Maryland where it is wet all year. I keep my two shaved up to the ergots all year. No scratches since my remedy. Good luck!
We recently purchased an OTTB who had a good case of scratches and a + fecal. After dosing with de-wormer per vet instructions (Equimax followed 2 weeks later by Ivermectin) and treating with this “homemade” concoction that required some ingredients from the vet, his scratches cleared up pretty nicely.
This is the recipe we were given; I also added a bit of gelatin to it as the scabs were very “horny” - it seems to have helped soften them a bit.
1/2 jar novalson 1/2 jAr Desiten or triple antibiotic ointment - mix well , add 2 cc dexamethazone & 3cc genycen - mix thoroughly - apply ever other day with a glove - try to keep area dry - after 2/3 applications take a mesh groom mitt and gently curry off.
YMMV - good luck!
https://www.argentoeq.com/products/leovet-bio-skin-oil
Unfortunately we’re out at the moment as they flew off the shelves but have more coming soon. I haven’t personally tried it yet (looking forward to it this summer when donkey gets terrible sweet itch) but people have said wonderful things about it. Its supposed to cure all sorts of skin problems. If you don’t want to wait smartpak sells it too
Apply original Listerine full strength daily to cure, and then prevent, just about any skin condition. Keep away from eyes and dock and sheath of course.
I have had luck with destin mixed with anti fungal from the vet and just destin
Well, I killed it. In addition to clipping the leg, washing with Hibiclens, drying with a hairdryer and applying whatever goop I started wrapping the leg 24/7 with cotton, vet rap, and elastikon.
Healed in a week after months of fighting. I did also change goop but I don’t really think that was the critical part. I did a few days of Biozide then moved to nitrofurazone.
After celebrating for one day I found a patch of ick on the opposite hind leg 
Here we go again. Roll on drier weather!
Have you addressed the nutritional deficiencies likely present?
If this horse is missing a nutrient I’d be shocked. His custom Horsetech supplement is over $200 a bucket, I had his hay and blood tested and used several vet consults and FeedXL to formulate his diet.
Probiotics?
That too. It’s not dietary.
An expensive custom mix doesn’t guarantee anything. It may guarantee that he’s not “deficient” according to NRC guidelines, but doesn’t at all guarantee he’s not deficient for his individual self
You’re dealing with ongoing chronic scratches. Wetness alone doesn’t make that happen for 99% of horses, IME.
So where do you suggest I look for deficiencies? Both my vet and nutritionist say his diet and blood work is great.
That’s already been stated - copper and zinc, or Vit A, or both (as in all 3) are the most likely culprits. You’re just not really going to see major deficiencies in those in the blood, and “normal” bloodwork is really just based on what is normal in terms of not diseased or major issues.
That’s why I said that individuals can need some to quite a lot more than what is “normal”.
According to my calculations he’s getting 126-135% of his needs for each of those with all the usual ratios looking good too. How much more does he need?
Xan, I had to up my horses’ zinc and copper because of the iron in our water. You may not have the “full picture” if you’re looking at your hay test + your grain + your supplements.
I gave a half scoop each of play copper and poly zinc from Uckele (HorseTech sells an identical/similar product) and saw the scratches clear up with pretty much zero work on my part in perhaps two weeks.
I did have an iron blood test done specifically and separately to other blood work and it came back normal… 
His blood iron should be normal. That isn’t the issue.
When there is too much iron in the forage, as there often is, copper and zinc uptake is decreased. That’s why number crunching doesn’t always mean it’s the whole picture. So yes to what Simkie said. And how much you need for that horse depends on that horse, but IME, the amounts she listed are not enough to cause OD issues, and usually enough to deal with this issue, if this IS the issue (and often it is).
I am amazed at the variety of suggestions, but I have another one. A good friend developed a salve that has worked successfully on a variety of issues and has the photos to show the healing progression.
Denise’s All Heal Salve - Note - I get no kickbacks, just want to pass the info on. Its been difficult to get people to try something new, but this stuff works on scratches, phythois, thrush, etc. All ingredients are natural and its safe to eat it. It will dextox your system. Check out here website - She will discuss the issue, suggest a healing program and believe me it works. I keep a jar in the trailer, barn, and at home.
Here are the products, xan:
That’s $20 to potentially totally solve your scratches issue, with nearly no effort required 
Why not try it?
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