Flexible tactile electronic skin （E-skin）， as a core carrier bridging the physical world and the digital realm， is essential for the next-generation medical healthcare and human-machine integration. Within the current research paradigms for high-performance flexible tactile E-skin， introducing force-sensitive microstructures represents an efficient and universal strategy， such as typical microstructures of grids， pyramids， domes， cilia， etc. However， this approach poses unprecedented technical challenges to the highly reliable manufacturing of flexible tactile E-skin.3D printing technology based on direct ink writing （DIW） has emerged as one of the key methods to achieve customized manufacturing of high-performance E-skin， owing to its exceptional material compatibility and cross-scale microstructure fabrication capabilities. This review provides a comprehensive summary of the recent advances in DIW-enabled flexible tactile E-skins. The rheological principles that govern the printability of inks are first discussed， with a focused emphasis on the roles of shear-thinning behavior and viscoelasticity in maintaining structural fidelity. Representative DIW-designed microarchitectures， including orthogonal lattices， hierarchical porous structures， and bioinspired ciliary arrays， are subsequently highlighted to reveal their impacts on sensitivity， linearity， and hysteresis. Applications in pulse monitoring， gait analysis， and robotic manipulation further demonstrate the great potential of DIW in constructing complex sensing systems. Finally， the review concludes by discussing the current challenges and future opportunities from the perspectives of multifunctional ink design， multimodal structural integration， and system-level development.