Each patch starts off as a little lump and then the top layer of the skin falls off with the hair attached. It is sad as little clumps of his hair fall our when you stroke or groom him, it feels really awful pulling his hair off, but the infection is under these pieces of skin, so it is better to have it come off so the area can dry and any treatment can get in.
We are currently treating it by spraying him with dilute TCP and working it in with our fingers to get it over as much of his skin as possible. We have a limited supply and it takes quite a bit to cover him so we have ordered some stuff called hibiscrub which is recommended along with an anticeptic shampoo. Some people suggest spraying regularly with diluted listerine (one person suggestd this worked well for her as a preventative during the winter). We may give that a go when other things fail! It seems that different things work on different horses - but all take a certain amount of work and regular application.
We could give him a course of antibiotics, but it seems this is only called for if less drastic measures fail to resolve the problem and it is better to find a another solution as it will tend to reoccur.
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