Don’t forget emacs. It has artist-mode.

TIL: https://www.emacswiki.org/emacs/ArtistMode

Vim’s modal editing, sans plugins, works surprisingly well for drawing too. Visual block mode is also helpful. At least in my experience, I built a puzzle game with pixel art elements[1] and I drew the initial puzzles in vim.

[1]: https://apps.apple.com/app/nonoverse-nonogram-puzzles/id6748...