Pilothouse designs make the most sense in coastal cruisers when extended off-season sailing is planned, and so can be desirable in our area (PNW) for those that like to use the boat year round.
There is a huge variety of designs, some leaning towards function and others trying a little harder to maintain attractive lines. Most pilothouse designs that have good visibility from the inside steering stn (why have a pilothouse without one?) will tend to have large windows, a liability at least and a possible bluewater hazard in severe seas.
Windage is, of course, increased as well, but the biggest negative for most of these designs is extremely compromised visibility from the aft cockpit (with the exception of the Nauticats)
Pilothouse designs tend to look "chunky" until you get to and above the 50foot overall range. Two exceptions to this are Garden designed Gulf 29 and 32, which have relatively low pilothouses, but inside visibility is not great. Of the PNW built options in the 40 foot range, the Cooper 416 and the Sceptre 41/43 each take a different approach, with the Sceptre the sleeker of the two.
P/H designs don't make much sense for the tropics, IMO.