Advanced epidermal electronic devices, capable of real-time monitoring of physical, physiological, and biochemical signals and administering appropriate therapeutics, are revolutionizing personalized healthcare technology. However, conventional portable electronic devices are predominantly constructed from impermeable and rigid materials, which thus leads to the mechanical and biochemical disparities between the devices and human tissues, resulting in skin irritation, tissue damage, compromised signal-to-noise ratio (SNR), and limited operational lifespans. To address these limitations, a new generation of wearable on-skin electronics built on stretchable and porous substrates has emerged. These substrates offer significant advantages including breathability, conformability, biocompatibility, and mechanical robustness, thus providing solutions for the aforementioned challenges. However, given their diverse nature and varying application scenarios, the careful selection and engineering of suitable substrates is paramount when developing high-performance on-skin electronics tailored to specific applications. This comprehensive review begins with an overview of various stretchable porous substrates, specifically focusing on their fundamental design principles, fabrication processes, and practical applications. Subsequently, a concise comparison of various methods is offered to fabricate epidermal electronics by applying these porous substrates. Following these, the latest advancements and applications of these electronics are highlighted. Finally, the current challenges are summarized and potential future directions in this dynamic field are explored.