By Mary Gaitskill. Pantheon Books, 227 pp, $33, hardcover.

The protagonist in National Book Award finalist Veronica goes from discussing enemas with her fellow fashion models, standing high-heeled and naked backstage at a runway show in Paris, to cleaning the filthy toilet of a pet photographer in San Rafael, California. Beauty and shit-beauty and ugliness-are not mutually exclusive in Mary Gaitskill's new novel, a deep-tissue-damaging chronicle of a strange friendship between a beautiful model and an unbeautiful copy editor that claws open our pretty, shiny exteriors to reveal the ugly, fetid "hide with bristles" lurking just beneath.

Gaitskill, who dissected an oddball pair of women in Two Girls, Fat and Thin, has an electrically painful instinct for poking and piercing wounded flesh. Here, Alison Owen is a once-Modigliani- esque cover girl, now middle-aged, disabled, and with a face that is "broken, with age and pain coming through the cracks". In one hepatitis C-feverish day, her thoughts search through a "bright and scalding" past as a photogenic star nymphet in the desperate and glittering world of '80s high fashion. She bitterly recalls "money and rich things and people kissing my ass"; boxes of syringes in the fridge "filled with antibiotics for syphilis and clap", "cocaine in a big china plate on the mantel", and gorgeous party people, all "lush arms" and "gold skin".

Alison's mind twists obsessively to memories of the abrasive, hideously dressed, Judy Garland-loving Veronica, whom she befriends in New York and who later dies from AIDS, thanks to her flagrantly unfaithful bisexual boyfriend. Alison bluntly admits that "when I knew Veronica I was healthy and beautiful and I thought I was so great for being friends with someone who was ugly and sick."

Gaitskill is a bitingly creative stylist, and similes and metaphors squirm like ticks under the grim exterior of her material: "a whine comes into my voice like an animal showing its ass"; "a sly sad look comes out of his eye like a tiny eye on a stalk"; and "his lips made me think of a spider drinking blood with pure blank bliss." But elegant edginess doesn't elbow out soulful themes of beauty and ugliness, sex and rage, guilt and redemption, and, most potently, detachment, loneliness, and the fear of terrible things "that can't be said". Characters "bite other people in an attempt to find them and when that doesn't work you bite yourself". Their monstrous need both to expose the hidden "meat of truth" under the surface and to recoil in horror is all too palpable.